Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME0066248 | FL |
NPI | 1316080682 |
---|---|
Provider Name | Steven Santiago |
First Address | Miami, FL 33137-3840 |
Second Address | Miami, FL 33137-3840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251270000 | (05) | FL |
F67289 | (02) | FL |