Provider Demographics
NPI:1659699643
Name:DELOSSANTOS, LYDIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:J
Last Name:DELOSSANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 MAYFAIR CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2932
Mailing Address - Country:US
Mailing Address - Phone:813-884-5399
Mailing Address - Fax:
Practice Address - Street 1:20101 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-7002
Practice Address - Country:US
Practice Address - Phone:813-996-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31820261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health