Healthcare Provider Details

I. General information

NPI: 1437079894
Provider Name (Legal Business Name): LUIS MANUEL SANTOS VIDOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CARR 2 # KM
BARCELONETA PR
00617-3338
US

IV. Provider business mailing address

2900 CARR. 686 ATLANTIC VIEW COURT, APT J 204
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-4583
  • Fax:
Mailing address:
  • Phone: 787-692-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8699
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: