| Organization Name: | GREGORIO S SANTOS MD PA |
| NPI Number: | 1306156104 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORIO S SANTOS (OWNER) |
| Mailing Address: | 6125 54th Ave N Ste B Kenneth City |
| State: | FL US |
| Postal Code: | 337091830 |
| Phone Number: | 7275219467 |
| Fax Number: | 7275210416 |
| NPI Enumeration Date: | 10/14/2010 |
| NPI Last Update Date: | 11/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | ME0072417 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |