Provider Demographics
NPI:1396767521
Name:SANTOS, KATIA GOM (MD)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:GOM
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIA
Other - Middle Name:
Other - Last Name:COXHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4142 MARINER BLVD # 414
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2468
Mailing Address - Country:US
Mailing Address - Phone:352-684-5299
Mailing Address - Fax:352-688-8744
Practice Address - Street 1:12440 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-684-5299
Practice Address - Fax:352-688-8744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96282208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
I61044Medicare UPIN
FLU8129ZMedicare PIN