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NPI Code Detail

MEDICARE: PEDRO MENA SANTOS

MEDICARE:   PEDRO  MENA SANTOS
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
1363LP2300XPrimary Care Nurse Practitioner11018781FL

General Provider Information

NPI Number : 1164172854
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEDRO MENA SANTOS
Provider Business Mailing Address
First Line : 5441 W 24TH AVE APT 36
Second Line :
City : HIALEAH
State : FL
Zip : 33016-4716
Country : US
Telephone Number : 786-484-6057
Fax Number :
Provider Business Practice Location Address
First Line : 5441 W 24TH AVE APT 36
Second Line :
City : HIALEAH
State : FL
Zip : 33016-4716
Country : US
Telephone Number : 786-484-6057
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2022
Last Update Date : 03/25/2022

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Directions to “ PEDRO MENA SANTOS ” Practice Location

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