Provider Demographics
NPI:1578167334
Name:SANTANA, CARLOS FELIPE
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:FELIPE
Last Name:SANTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA FLORIDA
Mailing Address - Street 2:93 CALLE CAOBA
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9676
Mailing Address - Country:US
Mailing Address - Phone:787-678-3027
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA FLORIDA
Practice Address - Street 2:CALLE 1 A32
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-678-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR737156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00747OtherLICENSE