Provider Demographics
NPI:1295085835
Name:SANTANA, JULIO GONZALEZ (CMA)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:GONZALEZ
Last Name:SANTANA
Suffix:
Gender:M
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 TANNERY LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:ME
Mailing Address - Zip Code:04949-3614
Mailing Address - Country:US
Mailing Address - Phone:073-231-4992
Mailing Address - Fax:
Practice Address - Street 1:53 TANNERY LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:ME
Practice Address - Zip Code:04949-3614
Practice Address - Country:US
Practice Address - Phone:207-323-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME376K00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide