Provider Demographics
NPI:1366581118
Name:DE LOS SANTOS, ROSANA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSANA
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4222
Mailing Address - Country:US
Mailing Address - Phone:786-243-1990
Mailing Address - Fax:786-243-9095
Practice Address - Street 1:1272 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-3232
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-688-7995
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91435208D00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME91435OtherMEDICAL LICENSE
FL267763600Medicaid
FL267763600Medicaid
FLU1640AMedicare ID - Type Unspecified