Provider Demographics
NPI:1225321060
Name:GOMEZ-SANTANA, ISABEL C (MA)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:C
Last Name:GOMEZ-SANTANA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 NW 79TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6546
Mailing Address - Country:US
Mailing Address - Phone:305-418-9222
Mailing Address - Fax:305-418-9006
Practice Address - Street 1:3900 NW 79TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6546
Practice Address - Country:US
Practice Address - Phone:305-418-9222
Practice Address - Fax:305-418-9006
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist