Provider Demographics
NPI:1396075057
Name:SANTOS, REMBERTO
Entity type:Individual
Prefix:
First Name:REMBERTO
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 AVENTURA BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3124
Mailing Address - Country:US
Mailing Address - Phone:305-931-7960
Mailing Address - Fax:305-931-7957
Practice Address - Street 1:2925 AVENTURA BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3124
Practice Address - Country:US
Practice Address - Phone:305-931-7960
Practice Address - Fax:305-931-7957
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCU534YOtherMEDICARE PTAN LINKED TO GROUP FT883A
FL002000400Medicaid
FLCU534ZOtherMEDICARE INDIVIDUAL PTAN