Provider Demographics
NPI:1013907088
Name:SANTAYANA, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:SANTAYANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:
Other - Last Name:SANTAYANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:4803 TANNERY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4533
Mailing Address - Country:US
Mailing Address - Phone:813-960-0880
Mailing Address - Fax:813-932-1923
Practice Address - Street 1:3201 W WATERS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2879
Practice Address - Country:US
Practice Address - Phone:813-932-7303
Practice Address - Fax:813-932-1923
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1334389007OtherCIGNA
FL870408859OtherHUMANA
FL069519000Medicaid
FL1334389007OtherCIGNA
FL069519000Medicaid