Provider Demographics
NPI:1619514114
Name:SANTANA-BERROA, ANYI PAOLA
Entity Type:Individual
Prefix:
First Name:ANYI
Middle Name:PAOLA
Last Name:SANTANA-BERROA
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 1:3221 FESCUE CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3241
Mailing Address - Country:US
Mailing Address - Phone:678-891-9572
Mailing Address - Fax:
Practice Address - Street 1:3221 FESCUE CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3241
Practice Address - Country:US
Practice Address - Phone:678-891-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer