Provider Demographics
NPI:1669611653
Name:SANTOS, RIA ASISTIN (MD)
Entity type:Individual
Prefix:DR
First Name:RIA
Middle Name:ASISTIN
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RIA
Other - Middle Name:
Other - Last Name:ASISTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-371-1153
Mailing Address - Fax:859-647-5113
Practice Address - Street 1:7766 EWING BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7537
Practice Address - Country:US
Practice Address - Phone:859-371-1153
Practice Address - Fax:859-647-5113
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100097500Medicaid
OH3079761Medicaid
KYP00750395OtherRAILROAD MEDICARE
KYP00856620OtherRAILROAD MEDICARE
KY0398330Medicare PIN
KY0403751Medicare PIN
KY7100097500Medicaid