Healthcare Provider Details

I. General information

NPI: 1902716954
Provider Name (Legal Business Name): MAYDA M GARCIA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 DAVISTON ST
SPRINGFIELD MA
01108-2225
US

IV. Provider business mailing address

82 WENDELL AVE STE 100
PITTSFIELD MA
01201-7066
US

V. Phone/Fax

Practice location:
  • Phone: 413-966-4545
  • Fax:
Mailing address:
  • Phone: 413-966-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: