Provider Demographics
NPI:1609523109
Name:GIL SANTANA, ELIANY
Entity Type:Individual
Prefix:
First Name:ELIANY
Middle Name:
Last Name:GIL SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4491 NW 163RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6018
Mailing Address - Country:US
Mailing Address - Phone:786-630-3981
Mailing Address - Fax:
Practice Address - Street 1:3219 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5308
Practice Address - Country:US
Practice Address - Phone:305-261-6633
Practice Address - Fax:305-261-6680
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB753570106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty