Provider Demographics
NPI:1649656323
Name:PENA SANTIAGO, DAYHANA (MD)
Entity type:Individual
Prefix:
First Name:DAYHANA
Middle Name:
Last Name:PENA SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SW 129TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1716
Mailing Address - Country:US
Mailing Address - Phone:754-888-9088
Mailing Address - Fax:954-800-6031
Practice Address - Street 1:1 SW 129TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1761
Practice Address - Country:US
Practice Address - Phone:754-888-9088
Practice Address - Fax:954-800-6031
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162799207Q00000X
SC51891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCC916J577OtherMEDICARE PIN
SCSCC916H888OtherMEDICARE PIN
SC518915Medicaid
SCSCC916H888OtherMEDICARE PIN