Provider Demographics
NPI:1508416181
Name:SANTOS, FREDDY
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 197TH ST APT A61
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2330
Mailing Address - Country:US
Mailing Address - Phone:347-567-4919
Mailing Address - Fax:
Practice Address - Street 1:117 W 197TH ST APT A61
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2330
Practice Address - Country:US
Practice Address - Phone:347-567-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor