Provider Demographics
NPI:1992530075
Name:SANTOS, IRENE CRYSTAL (RN)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:CRYSTAL
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:CRYSTAL
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12105 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1611
Mailing Address - Country:US
Mailing Address - Phone:305-308-6652
Mailing Address - Fax:
Practice Address - Street 1:12105 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1611
Practice Address - Country:US
Practice Address - Phone:305-308-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9624951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse