Healthcare Provider Details

I. General information

NPI: 1285538769
Provider Name (Legal Business Name): SAMUEL SANTOS PAULON I PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 N ANDREWS AVENUE EXT
POMPANO BEACH FL
33064-2067
US

IV. Provider business mailing address

2600 NE 8TH TER
POMPANO BEACH FL
33064-6411
US

V. Phone/Fax

Practice location:
  • Phone: 954-368-1302
  • Fax:
Mailing address:
  • Phone: 954-902-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3278
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTPPA1391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: