Basic Information
| Provider Information | |||||||||
| NPI: | 1518060409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LOS SANTOS | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N.W. 12 ST. | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862431990 | ||||||||
| FaxNumber: | 7862439590 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N.W. 12 ST. | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862431990 | ||||||||
| FaxNumber: | 7862439590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME86285 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.