Provider Demographics
NPI:1538132097
Name:SANTANA, ERENIO CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:ERENIO
Middle Name:CARLOS
Last Name:SANTANA
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 1:1416 SAN MARCO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2256
Mailing Address - Country:US
Mailing Address - Phone:305-461-4533
Mailing Address - Fax:
Practice Address - Street 1:3641 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4205
Practice Address - Country:US
Practice Address - Phone:305-854-0300
Practice Address - Fax:305-854-0308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85879207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71469OtherBLUE CROSS B
71469ZMedicare ID - Type Unspecified
FL71469OtherBLUE CROSS B