Provider Demographics
NPI:1154510212
Name:GERARDO SANTOS PSYD P A
Entity Type:Organization
Organization Name:GERARDO SANTOS PSYD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-777-3881
Mailing Address - Street 1:6625 MIAMI LAKES DR
Mailing Address - Street 2:SUITE 326
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2708
Mailing Address - Country:US
Mailing Address - Phone:305-777-3881
Mailing Address - Fax:305-777-3802
Practice Address - Street 1:6625 MIAMI LAKES DR
Practice Address - Street 2:SUITE 326
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-777-3881
Practice Address - Fax:305-777-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7282OtherLICENSE
FLPY7282OtherLICENSE