Provider Demographics
NPI:1821812462
Name:SANTOS, GABRYEL (PA-C)
Entity type:Individual
Prefix:
First Name:GABRYEL
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 JAVA RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-8104
Mailing Address - Country:US
Mailing Address - Phone:803-804-6682
Mailing Address - Fax:
Practice Address - Street 1:13649 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-5829
Practice Address - Country:US
Practice Address - Phone:803-266-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant