Healthcare Provider Details

I. General information

NPI: 1518261353
Provider Name (Legal Business Name): MATILDE C SANTOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1340
US

IV. Provider business mailing address

2067 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1340
US

V. Phone/Fax

Practice location:
  • Phone: 617-575-5570
  • Fax: 617-575-5560
Mailing address:
  • Phone: 617-575-5570
  • Fax: 617-575-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN196705
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: