Provider Demographics
NPI:1811139520
Name:TRUJILLO SANTIAGO, LEOMARIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LEOMARIS
Middle Name:A
Last Name:TRUJILLO SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 BROADWAY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5760
Mailing Address - Country:US
Mailing Address - Phone:787-276-7043
Mailing Address - Fax:787-759-8411
Practice Address - Street 1:222 BROADWAY UNIT 202
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5760
Practice Address - Country:US
Practice Address - Phone:787-276-7043
Practice Address - Fax:787-759-8411
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17441208D00000X
FLACN1099208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice