Provider Demographics
NPI:1700025319
Name:SANTANA, MIRIAM ENID (MT)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ENID
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CALLE 25 DE JULIO
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-2713
Mailing Address - Country:US
Mailing Address - Phone:787-821-2610
Mailing Address - Fax:787-821-0268
Practice Address - Street 1:45 CALLE 25 DE JULIO
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2713
Practice Address - Country:US
Practice Address - Phone:787-821-2610
Practice Address - Fax:787-821-0268
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1888246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38306OtherMEDICARE ID