Provider Demographics
NPI:1447280680
Name:SANTOS, ANGELITO G (MD)
Entity type:Individual
Prefix:
First Name:ANGELITO
Middle Name:G
Last Name: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 1:821 RENMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4219
Mailing Address - Country:US
Mailing Address - Phone:954-306-8411
Mailing Address - Fax:954-306-8411
Practice Address - Street 1:548 S MARINE CORPS DR
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3539
Practice Address - Country:US
Practice Address - Phone:671-646-5825
Practice Address - Fax:671-646-0556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37917207P00000X
CAC53333207P00000X
GUM-1605207P00000X
AZ40092207P00000X
FLME0065167208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32882OtherBCBS
FL252078800Medicaid
FLF41605Medicare UPIN
FL32882OtherBCBS