Provider Demographics
NPI:1134259773
Name:DE LOS SANTOS, JUAN MARIO (ARNP)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MARIO
Last Name:DE LOS SANTOS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13737 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7208
Mailing Address - Country:US
Mailing Address - Phone:305-559-0495
Mailing Address - Fax:305-559-0495
Practice Address - Street 1:10661 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1550
Practice Address - Country:US
Practice Address - Phone:305-670-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1945092372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider