Provider Demographics
NPI:1164427332
Name:SANTI, CELESTINO DAVID (DO)
Entity Type:Individual
Prefix:
First Name:CELESTINO
Middle Name:DAVID
Last Name:SANTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4361
Mailing Address - Country:US
Mailing Address - Phone:352-742-1500
Mailing Address - Fax:352-742-9024
Practice Address - Street 1:2020 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4361
Practice Address - Country:US
Practice Address - Phone:352-742-1500
Practice Address - Fax:352-742-9024
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-09-23
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLOS5229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062412800Medicaid
FL062412800Medicaid
FLD79310Medicare UPIN
FL80305Medicare PIN