Provider Demographics
NPI:1831159730
Name:SANTOS, JOCELYN
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:CRUZ
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2525 E CAMELBACK RD
Mailing Address - Street 2:SUITEN1100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4219
Mailing Address - Country:US
Mailing Address - Phone:602-618-9112
Mailing Address - Fax:602-778-3619
Practice Address - Street 1:101 CIVIC CENTER LN
Practice Address - Street 2:APOGEE PHYSICIANS OFFICE
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5607
Practice Address - Country:US
Practice Address - Phone:928-302-5402
Practice Address - Fax:928-302-5906
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00263103OtherRR MEDICARE
AZ45085903Medicaid
AZAZ0780580OtherBCBS
AZG88015Medicare UPIN
AZ45085903Medicaid
AZAZ0780580OtherBCBS