Provider Demographics
NPI:1326097346
Name:SANTA MARIA, RODERICK (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:SANTA MARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MEADOWS RD
Mailing Address - Street 2:121
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-338-0730
Mailing Address - Fax:561-347-0512
Practice Address - Street 1:801 MEADOWS RD
Practice Address - Street 2:121
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-338-0730
Practice Address - Fax:561-347-0512
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61250Medicare ID - Type Unspecified
D57157Medicare UPIN