Basic Information
Provider Information
NPI: 1760689061
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANTOS
FirstName: ROLANDO
MiddleName: RUIZ
NamePrefix: DR.
NameSuffix:  
Credential: M.D., M.H.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SANTOS
OtherFirstName: ROLANDO ANTONIO
OtherMiddleName: RUIZ
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 5
Mailing Information
Address1: ONE HOSPITAL PLAZA
Address2:  
City: STAMFORD
State: CT
PostalCode: 06904
CountryCode: US
TelephoneNumber: 2032767298
FaxNumber: 2032764842
Practice Location
Address1: ONE HOSPITAL PLAZA
Address2:  
City: STAMFORD
State: CT
PostalCode: 06904
CountryCode: US
TelephoneNumber: 2032767298
FaxNumber: 2032764842
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 04/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X047668CTY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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