Provider Demographics
NPI:1679531198
Name:SANTOS, GUILLERMO A (DO)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:SANTOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4452
Mailing Address - Country:US
Mailing Address - Phone:305-888-2607
Mailing Address - Fax:305-888-5161
Practice Address - Street 1:230 PARK ST
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4452
Practice Address - Country:US
Practice Address - Phone:305-888-2607
Practice Address - Fax:305-888-5161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3149Medicare ID - Type Unspecified
FLG29847Medicare UPIN