Provider Demographics
NPI:1851343578
Name:SANTOS, CARLOS R (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16855 NE 2ND AVE
Mailing Address - Street 2:STE 302A
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-653-0425
Mailing Address - Fax:305-653-4055
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:SUITE 302 A
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-653-0425
Practice Address - Fax:305-653-4055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81286207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58785Medicare ID - Type Unspecified