Provider Demographics
NPI:1760164347
Name:SANTIAGO ROJAS, KENNIE JOSE (SA-C)
Entity Type:Individual
Prefix:
First Name:KENNIE
Middle Name:JOSE
Last Name:SANTIAGO ROJAS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 BAYWATER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3542
Mailing Address - Country:US
Mailing Address - Phone:832-542-5871
Mailing Address - Fax:
Practice Address - Street 1:5404 BAYWATER DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3542
Practice Address - Country:US
Practice Address - Phone:832-542-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-400246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant