Provider Demographics
NPI:1336481365
Name:SANTANA, SERGIO ENRIQUE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ENRIQUE
Last Name:SANTANA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SW 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2753
Mailing Address - Country:US
Mailing Address - Phone:786-368-7353
Mailing Address - Fax:
Practice Address - Street 1:5900 SW 150TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2753
Practice Address - Country:US
Practice Address - Phone:786-368-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10856224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant