Provider Demographics
NPI:1376177345
Name:SANTANA HERNANDEZ, ANNELIESSE
Entity Type:Individual
Prefix:
First Name:ANNELIESSE
Middle Name:
Last Name:SANTANA HERNANDEZ
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 1:6447 MIAMI LAKES DR STE 203J
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2703
Mailing Address - Country:US
Mailing Address - Phone:786-542-5018
Mailing Address - Fax:786-542-5063
Practice Address - Street 1:6447 MIAMI LAKES DR STE 203J
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2703
Practice Address - Country:US
Practice Address - Phone:786-542-5018
Practice Address - Fax:786-542-5063
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management