Provider Demographics
NPI:1710188255
Name:SANTAMARIA, JOSE LUIS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:SANTAMARIA
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 1:11200 W FLAGLER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4210
Mailing Address - Country:US
Mailing Address - Phone:305-552-6133
Mailing Address - Fax:305-552-6048
Practice Address - Street 1:11200 W FLAGLER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4210
Practice Address - Country:US
Practice Address - Phone:305-552-6133
Practice Address - Fax:305-552-6048
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant