MEDICARE: SANTOS INTERVENTIONAL PAIN MEDICINE P.C.

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1194022087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTOS INTERVENTIONAL PAIN MEDICINE P.C.

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	STE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	7190 SMOKE RANCH RD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8397
Country	:	US
Telephone Number	:	702-434-7246
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CRISPINO SANTOS
Credential	:	M.D.
Telephone Number	:	702-434-7246

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	11/04/2013

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