MEDICARE: DR. GUILLERMO A. SANTOS D.O.

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	207Q00000X	Family Medicine Physician	OS9077	FL

General Provider Information

NPI Number	:	1679531198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUILLERMO A. SANTOS D.O.

Provider Business Mailing Address
First Line	:	230 PARK ST
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4452
Country	:	US
Telephone Number	:	305-888-2607
Fax Number	:	305-888-5161

Provider Business Practice Location Address
First Line	:	230 PARK ST
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4452
Country	:	US
Telephone Number	:	305-888-2607
Fax Number	:	305-888-5161

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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