Provider Demographics
NPI:1851922314
Name:SANTOS, GLADYS YSABEL (BS)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:YSABEL
Last Name:SANTOS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2451
Mailing Address - Country:US
Mailing Address - Phone:561-709-2281
Mailing Address - Fax:561-557-6711
Practice Address - Street 1:5305 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2451
Practice Address - Country:US
Practice Address - Phone:561-709-2281
Practice Address - Fax:561-557-6711
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLCBHCM102851171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator