Healthcare Provider Details

I. General information

NPI: 1356045736
Provider Name (Legal Business Name): SANTOS MEDICAL CENTER MIAMI LAKES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15910 NW 57TH AVE
MIAMI LAKES FL
33014-6704
US

IV. Provider business mailing address

13780 SW 26TH ST
MIAMI FL
33175-6302
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-4595
  • Fax: 305-553-4596
Mailing address:
  • Phone: 786-344-9819
  • Fax: 305-554-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ORQUIDEA SANTOS
Title or Position: OWNER
Credential:
Phone: 786-344-9819