Provider Demographics
NPI:1558318923
Name:SANTIAGO, CARLOS E (MDFACS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MDFACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 S RED RD STE 504
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3644
Mailing Address - Country:US
Mailing Address - Phone:305-669-7331
Mailing Address - Fax:305-669-7337
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:SUITE 504
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-669-7331
Practice Address - Fax:305-669-7337
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046772300Medicaid
FL04169WMedicare PIN
FL046772300Medicaid