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General NPI Number Information
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NPI Number | 1578800454
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Entity Type | Organization
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Legal Business Name | BERNADETTE SANTOS MD PA
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 1503 BUENOS AIRES BLVD STE 180
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City | THE VILLAGES
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-323-1482
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Fax | 352-259-0748
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Provider Business Mailing Address
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Address Line | 121A LAGRANDE BLVD STE A
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City | LADY LAKE
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State | FL
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Zip | 32159-1302
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Country | US
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Telephone | 352-753-0581
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Fax | 352-753-2078
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Authorized Official
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Title or Position | OWNER
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Name | DR. BERNADETTE SANTOS
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Credential | MD
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Telephone | 352-753-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME81152
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License Number State | FL
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