Provider Demographics
NPI:1043256472
Name:VIERA SANTOS, CARLOS FERMIN (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:FERMIN
Last Name:VIERA SANTOS
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 1:1903 HOLLYHOCK RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8651
Mailing Address - Country:US
Mailing Address - Phone:561-804-1237
Mailing Address - Fax:
Practice Address - Street 1:1840 FOREST HILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6063
Practice Address - Country:US
Practice Address - Phone:561-964-1181
Practice Address - Fax:561-964-1196
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274815100Medicaid
FL150897Medicare UPIN
FL36305AMedicare ID - Type Unspecified