Provider Demographics
NPI:1720601909
Name:SANTANA CARO, STEPHANIE D
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:SANTANA CARO
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 1:7110 NW 179TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5461
Mailing Address - Country:US
Mailing Address - Phone:786-219-8907
Mailing Address - Fax:
Practice Address - Street 1:7110 NW 179TH ST APT 208
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5461
Practice Address - Country:US
Practice Address - Phone:786-219-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician