Provider Demographics
NPI: | 1013985332 |
---|---|
Name: | SANTORO, JOSE E (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | JOSE |
Middle Name: | E |
Last Name: | SANTORO |
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: | 5630 HOLLYWOOD BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | HOLLYWOOD |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33021-6351 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-672-4240 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5630 HOLLYWOOD BLVD |
Practice Address - Street 2: | |
Practice Address - City: | HOLLYWOOD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33021-6351 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-672-4240 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-03-11 |
Last Update Date: | 2023-01-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | L3812 | 207L00000X |
LA | 308260 | 207L00000X |
OK | 22889 | 207L00000X |
FL | ME116737 | 207LP2900X, 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 8BJ009 | Other | BCBS |
FL | 192DC | Other | BCBS |
TX | 198931101 | Medicaid |