Provider Demographics
NPI:1578044657
Name:SANTANA, MANUEL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11843 SW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5601
Mailing Address - Country:US
Mailing Address - Phone:305-898-5799
Mailing Address - Fax:
Practice Address - Street 1:2450 SW 137TH AVE STE 221
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6332
Practice Address - Country:US
Practice Address - Phone:305-228-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist