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General NPI Number Information
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NPI Number | 1487082707
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Entity Type | Individual
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Provider Name | DOMINGO A SANTOS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 6164 GRAND CYPRESS CIR
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City | LAKE WORTH
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State | FL
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Zip | 33463-7355
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Country | US
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Telephone | 561-385-9102
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Fax |
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Provider Business Mailing Address
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Address Line | 6164 GRAND CYPRESS CIR
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City | LAKE WORTH
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State | FL
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Zip | 33463-7355
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Country | US
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Telephone | 561-385-9102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | S532-161-63-460-0
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License Number State | FL
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