Provider Demographics
NPI:1811595580
Name:SANTIAGO, YUNIER
Entity Type:Individual
Prefix:
First Name:YUNIER
Middle Name:
Last Name:SANTIAGO
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 1:12834 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6214
Mailing Address - Country:US
Mailing Address - Phone:786-229-6830
Mailing Address - Fax:
Practice Address - Street 1:12834 SW 55TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6214
Practice Address - Country:US
Practice Address - Phone:786-229-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2021-02-24
Deactivation Date:2020-10-14
Deactivation Code:
Reactivation Date:2021-02-15
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-7258-267421103K00000X
FLRBT-20-140353103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty