Provider Demographics
NPI:1033841044
Name:CAPOTE SANTANDER, CARMEN ELISA (CASE MANAGER TCM)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ELISA
Last Name:CAPOTE SANTANDER
Suffix:
Gender:F
Credentials:CASE MANAGER TCM
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:ELISA
Other - Last Name:CAPOTE SANTANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDHCM 0104347
Mailing Address - Street 1:9298 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1704
Mailing Address - Country:US
Mailing Address - Phone:786-205-7213
Mailing Address - Fax:
Practice Address - Street 1:9298 JAMAICA DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1704
Practice Address - Country:US
Practice Address - Phone:786-205-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0104347171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator