MEDICARE: EDWIN EMILIO THOMAS SANTOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	23454	PR
2	208D00000X	General Practice Physician	23454	PR
3	207R00000X	Internal Medicine Physician	23454	PR

General Provider Information

NPI Number	:	1063035194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN EMILIO THOMAS SANTOS MD

Provider Business Mailing Address
First Line	:	239 CALLE PESANTE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 CALLE CUEVAS BUSTAMANTE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2683
Country	:	US
Telephone Number	:	787-758-8383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2020
Last Update Date	:	06/30/2026

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