Provider Demographics
NPI:1700912417
Name:SANTIAGO GONZALEZ, CARLOS YAMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:YAMIL
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12171 SW 268TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8001
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:
Practice Address - Street 1:2600 INDUSTRIAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-7135
Practice Address - Country:US
Practice Address - Phone:863-666-6100
Practice Address - Fax:863-248-4395
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15313OtherLICENSE