Healthcare Provider Details

I. General information

NPI: 1790479848
Provider Name (Legal Business Name): CARLOS GARCIA SANTOS-GALLEGO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MADISON AVE BLDG 6TH
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1255 5TH AVE APT 4E
NEW YORK NY
10029-3850
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8484
  • Fax:
Mailing address:
  • Phone: 646-400-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: