Provider Demographics
NPI:1053664995
Name:SANTOS, NUBIA (MS,MED, LMHC)
Entity Type:Individual
Prefix:
First Name:NUBIA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MS,MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SE 2ND AVE.
Mailing Address - Street 2:SUITE 313
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-1509
Mailing Address - Country:US
Mailing Address - Phone:561-212-9121
Mailing Address - Fax:305-359-9121
Practice Address - Street 1:25 SE 2ND AVE.
Practice Address - Street 2:SUITE 313
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1509
Practice Address - Country:US
Practice Address - Phone:561-212-9121
Practice Address - Fax:305-359-9121
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ04MROtherBCBS OF FL