Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | ME90335 | FL |
NPI | 1205873890 |
---|---|
Provider Name | Dr. Rafael Santiago |
First Address | Saint Petersburg, FL 33701 |
Second Address | Saint Petersburg, FL 33701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I08876 | (02) |