Provider Demographics
NPI:1679332266
Name:SANTOS, ROBERTO
Entity Type:Individual
Prefix:
First Name:ROBERTO
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 1:1604 HEART BAR RD
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5722
Mailing Address - Country:US
Mailing Address - Phone:689-261-1801
Mailing Address - Fax:407-887-9492
Practice Address - Street 1:1604 HEART BAR RD
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:FL
Practice Address - Zip Code:34744-5722
Practice Address - Country:US
Practice Address - Phone:689-261-1801
Practice Address - Fax:407-887-9492
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi