Basic Information
| Provider Information | |||||||||
| NPI: | 1023097581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | ALFREDO | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 S POMPANO PKWY | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330693001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549748901 | ||||||||
| FaxNumber: | 9549705382 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 S POMPANO PKWY | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330693001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549748901 | ||||||||
| FaxNumber: | 9549705382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME 45695 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 053084100 | 05 | FL | MEDICAID |