Provider Demographics
NPI:1003129669
Name:SAN MARTINE DE PORRAS
Entity Type:Organization
Organization Name:SAN MARTINE DE PORRAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUAITALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-9882
Mailing Address - Street 1:16861 SW 92ND CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4514
Mailing Address - Country:US
Mailing Address - Phone:305-305-9882
Mailing Address - Fax:
Practice Address - Street 1:16861 SW 92ND CT
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4514
Practice Address - Country:US
Practice Address - Phone:305-305-9882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10485310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility