Provider Demographics
NPI:1639383235
Name:SANTOS, TAMARA
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. FOREST HILLS
Mailing Address - Street 2:CALLE 25 C-21 L OCAL NUM.2
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-785-3374
Mailing Address - Fax:787-785-3374
Practice Address - Street 1:URB. FOREST HILLS
Practice Address - Street 2:CALLE 25 C-21 L OCAL NUM.2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-785-3374
Practice Address - Fax:787-785-3374
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR55292OtherTRIPLE-S PROVIDER ID