Provider Demographics
NPI:1376887117
Name:IDALIA M SANTAELLA MD LLC
Entity Type:Organization
Organization Name:IDALIA M SANTAELLA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTAELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-448-7213
Mailing Address - Street 1:PO BOX 140878
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-0878
Mailing Address - Country:US
Mailing Address - Phone:305-448-7213
Mailing Address - Fax:305-448-9282
Practice Address - Street 1:2307 DOUGLAS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3056
Practice Address - Country:US
Practice Address - Phone:305-448-7213
Practice Address - Fax:305-448-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-17
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0044084291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory