Provider Demographics
NPI:1205406105
Name:PEREZ SANTAMARIA, CARMEN M (RN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:PEREZ SANTAMARIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 W 56TH TER UNIT 410
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2006
Mailing Address - Country:US
Mailing Address - Phone:786-975-3069
Mailing Address - Fax:
Practice Address - Street 1:1748 W 56TH TER UNIT 410
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2006
Practice Address - Country:US
Practice Address - Phone:786-975-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9509041163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice