Provider Demographics
NPI:1649292558
Name:SANTANDER MEDICAL CENTER
Entity type:Organization
Organization Name:SANTANDER MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-940-7074
Mailing Address - Street 1:909 N MIAMI BEACH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3712
Mailing Address - Country:US
Mailing Address - Phone:305-940-7074
Mailing Address - Fax:305-940-7076
Practice Address - Street 1:909 N MIAMI BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3712
Practice Address - Country:US
Practice Address - Phone:305-940-7074
Practice Address - Fax:305-940-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7073261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty