Provider Demographics
NPI:1639534530
Name:VIERA SANTOS PEDIATRIC
Entity Type:Organization
Organization Name:VIERA SANTOS PEDIATRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:VIERA SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-779-1451
Mailing Address - Street 1:6801 LAKE WORTH RD
Mailing Address - Street 2:BUILDING NORTH ST 324
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE WORTH RD
Practice Address - Street 2:BUILDING NORTH ST 324
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2955
Practice Address - Country:US
Practice Address - Phone:561-779-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274815100Medicaid
=========OtherHUMANA MEDICAID
FL274815100Medicaid
=========OtherCIGNA
=========OtherFLORIDA BLUE
=========OtherPRESTIGE
=========OtherCMS T19
=========OtherHUMANA
=========OtherUNITED HEALTH CARE
=========OtherCMS SOUTHEAST FL