Provider Demographics
NPI:1871835017
Name:JOSE LUIS SANTAMARIA PA
Entity Type:Organization
Organization Name:JOSE LUIS SANTAMARIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-632-7752
Mailing Address - Street 1:8261 NW 8TH ST APT 334
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3965
Mailing Address - Country:US
Mailing Address - Phone:305-632-7752
Mailing Address - Fax:
Practice Address - Street 1:833 SW 29TH AVE STE 9
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4551
Practice Address - Country:US
Practice Address - Phone:305-642-4111
Practice Address - Fax:305-642-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty