Provider Demographics
NPI:1235767203
Name:SANTIAGO, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 S ORANGE BLOSSOM TRL # 11240
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9428
Mailing Address - Country:US
Mailing Address - Phone:407-704-2673
Mailing Address - Fax:407-613-5947
Practice Address - Street 1:11240 S ORANGE BLOSSOM TRL # 11240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9428
Practice Address - Country:US
Practice Address - Phone:407-704-2673
Practice Address - Fax:407-613-5947
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies