Provider Demographics
NPI:1740209105
Name:MONTOYA, SANTIAGO BERNABE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:BERNABE
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 651219
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-1219
Mailing Address - Country:US
Mailing Address - Phone:305-559-0278
Mailing Address - Fax:305-559-3608
Practice Address - Street 1:10404 W FLAGLER ST
Practice Address - Street 2:SUITE # 15
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1615
Practice Address - Country:US
Practice Address - Phone:305-559-0278
Practice Address - Fax:305-559-3608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0071746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250992000Medicaid
FL250992000Medicaid
FL32372AMedicare PIN