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General NPI Number Information
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NPI Number | 1104311315
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Entity Type | Organization
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Legal Business Name | SANTOS PRIMARY CARE MEDICAL CLINICS, PLLC
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 17820 SE 109TH AVE STE 108
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8968
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Country | US
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Telephone | 352-448-6469
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Fax | 352-504-0901
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Provider Business Mailing Address
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Address Line | 17820 SE 109TH AVE STE 108
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8968
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Country | US
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Telephone | 352-448-6469
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Fax | 352-504-0901
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Authorized Official
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Title or Position | PROVIDER
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Name | ADAMASTOR SANTOS
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Credential | PA
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Telephone | 352-448-6469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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