Provider Demographics
NPI:1225156565
Name:DE SANTIS, PASCUAL (MD)
Entity Type:Individual
Prefix:
First Name:PASCUAL
Middle Name:
Last Name:DE SANTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-595-9930
Mailing Address - Fax:786-576-0455
Practice Address - Street 1:9915 NW 41ST ST
Practice Address - Street 2:SUITE 230
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2445
Practice Address - Country:US
Practice Address - Phone:786-595-9930
Practice Address - Fax:786-576-0455
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98124207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278515300Medicaid
FL278515300Medicaid