Provider Demographics
NPI:1417091844
Name:SANTA MARIA, RAMON VIANZON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:VIANZON
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 1:4051 UPPER CREEK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6825
Mailing Address - Country:US
Mailing Address - Phone:813-633-2504
Mailing Address - Fax:813-633-2546
Practice Address - Street 1:4051 UPPER CREEK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6825
Practice Address - Country:US
Practice Address - Phone:813-633-2504
Practice Address - Fax:813-633-2546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67476Medicare UPIN