MEDICARE: MAXIMO SANTOS JR. DNP, NP-C, AAHIVS

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	363LP2300X	Primary Care Nurse Practitioner	95011233	CA

General Provider Information

NPI Number	:	1841620424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXIMO SANTOS JR. DNP, NP-C, AAHIVS

Provider Business Mailing Address
First Line	:	1043 ELM AVE STE 302
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3295
Country	:	US
Telephone Number	:	562-247-7592
Fax Number	:	562-432-5122

Provider Business Practice Location Address
First Line	:	1043 ELM AVE STE 302
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3295
Country	:	US
Telephone Number	:	562-247-7592
Fax Number	:	562-432-5122

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

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	05/09/2021

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