Active NPI
Santos Perez Custodio, DC
- Chiropractor
- Debary, FL
National Provider Identifier
1336869569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH13727
- Practice address
- 70 Fox Ridge CT
Debary, FL 32713-2752 - Phone
- (386) 668-6321
- NPI assigned
- Aug 29, 2022
- Last updated
- Aug 29, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH13727 | FL | Primary |
Addresses
Primary practice location
70 Fox Ridge CT
Debary, FL 32713-2752
Mailing address
3580 Fernanda Dr
Deltona, FL 32738-7120
Phone (787) 669-7786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1791 E Broadway St
Oviedo, FL 32765-9744
Phone (407) 359-2757
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacob Medical Associates LLC | Current | Accepting new patients | |
| Oviedo Medical Clinic, LLC | Chiropractor | Current | Accepting new patients |
| Dr Eric Janowitz PA | Chiropractor | Past | Accepting new patients |
Locations
1791 E Broadway St
Oviedo, FL 32765
Phone (407) 359-2757
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Geriatric Medicine (Internal Medicine) Physician
- Clermont, FL
- NPI 1174714414
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1336869569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3580 FERNANDA DR",
"city": "DELTONA",
"state": "FL",
"postal_code": "327387120",
"telephone_number": "787-669-7786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 FOX RIDGE CT",
"city": "DEBARY",
"state": "FL",
"postal_code": "327132752",
"telephone_number": "386-668-6321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ CUSTODIO",
"first_name": "SANTOS",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-29",
"last_updated": "2022-08-29",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH13727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Debary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.