Healthcare Provider Details

I. General information

NPI: 1518346725
Provider Name (Legal Business Name): ROXANN Z SANTOS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N WAYNE RD
WESTLAND MI
48185-1137
US

IV. Provider business mailing address

8623 N WAYNE RD
WESTLAND MI
48185-1137
US

V. Phone/Fax

Practice location:
  • Phone: 734-353-2626
  • Fax:
Mailing address:
  • Phone: 734-353-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: