Provider Demographics
NPI:1821265323
Name:SANTIN, ENMA (MD)
Entity Type:Individual
Prefix:
First Name:ENMA
Middle Name:
Last Name:SANTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W 12TH AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5154
Mailing Address - Country:US
Mailing Address - Phone:305-281-0588
Mailing Address - Fax:
Practice Address - Street 1:7000 W 12TH AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5154
Practice Address - Country:US
Practice Address - Phone:305-281-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 106404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME106404OtherFLORIDA LICENSE