Provider Demographics
NPI:1972001873
Name:SANTOS, TAILY
Entity Type:Individual
Prefix:
First Name:TAILY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 NW 27TH AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5132
Mailing Address - Country:US
Mailing Address - Phone:786-502-8969
Mailing Address - Fax:786-803-8226
Practice Address - Street 1:285 NW 27TH AVE STE 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5132
Practice Address - Country:US
Practice Address - Phone:786-502-8969
Practice Address - Fax:786-803-8226
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician