Provider Demographics
NPI:1851965982
Name:SANTINI, SOUVENIR MATTEO (PA)
Entity Type:Individual
Prefix:
First Name:SOUVENIR
Middle Name:MATTEO
Last Name:SANTINI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 NW 189TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3958
Mailing Address - Country:US
Mailing Address - Phone:754-204-7649
Mailing Address - Fax:
Practice Address - Street 1:571 NW 189TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3958
Practice Address - Country:US
Practice Address - Phone:754-204-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR206PA363AM0700X
PR0002062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical