Provider Demographics
NPI:1184765570
Name:SANTA-ANA, ALVIN RAFAEL
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:RAFAEL
Last Name:SANTA-ANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-4516
Mailing Address - Country:US
Mailing Address - Phone:786-499-3789
Mailing Address - Fax:786-499-3789
Practice Address - Street 1:203 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-4516
Practice Address - Country:US
Practice Address - Phone:786-499-3789
Practice Address - Fax:786-499-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184765570OtherNPI NUMBER
FL001982000Medicaid