Healthcare Provider Details

I. General information

NPI: 1578737185
Provider Name (Legal Business Name): CARLOS R SANTOS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16855 NE 2ND AVE SUITE 302A
N MIAMI BEACH FL
33162-1744
US

IV. Provider business mailing address

PO BOX 198704
ATLANTA GA
30384-8704
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-0803
  • Fax: 954-437-0680
Mailing address:
  • Phone: 954-437-0803
  • Fax: 954-437-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME81286
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS R SANTOS
Title or Position: OWNER
Credential: MD
Phone: 954-437-0803