MEDICARE: KELYN C DOS 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
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1275879587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELYN C DOS SANTOS

Provider Business Mailing Address
First Line	:	2200 BERQUIST DR
Second Line	:
City	:	APO
State	:	AA
Zip	:	78236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 BERGQUIST DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-9907
Country	:	US
Telephone Number	:	210-292-7331
Fax Number	:

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

Provider Enumeration Date	:	12/14/2012
Last Update Date	:	12/14/2012

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Directions to “ KELYN C DOS SANTOS ” Practice Location

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