Provider Demographics
NPI:1871838979
Name:SANTANA, AIDA IRIS (MA,)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:IRIS
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 BOB O LINK WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3340
Mailing Address - Country:US
Mailing Address - Phone:772-475-5856
Mailing Address - Fax:
Practice Address - Street 1:7424 BOB O LINK WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3340
Practice Address - Country:US
Practice Address - Phone:772-475-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health