Provider Demographics
NPI:1063677748
Name:SANTOS MC LLC
Entity Type:Organization
Organization Name:SANTOS MC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-636-9637
Mailing Address - Street 1:28803 8 MILE RD
Mailing Address - Street 2:102
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2074
Mailing Address - Country:US
Mailing Address - Phone:248-636-9637
Mailing Address - Fax:
Practice Address - Street 1:28803 8 MILE RD
Practice Address - Street 2:102
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2074
Practice Address - Country:US
Practice Address - Phone:248-636-9637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center