Healthcare Provider Details

I. General information

NPI: 1588198105
Provider Name (Legal Business Name): RACHEL SANTOS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL WILLIMANN DO

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 800S
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE STE 800S
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-614-4270
  • Fax:
Mailing address:
  • Phone: 914-614-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number310845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: