Provider Demographics
NPI:1861435026
Name:SANTIAGO, FERNANDO LUIS (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:SANTIAGO
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 1:1685 LEE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2235
Mailing Address - Country:US
Mailing Address - Phone:407-303-6729
Mailing Address - Fax:407-628-2037
Practice Address - Street 1:265 E ROLLINS ST # 6
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5502
Practice Address - Country:US
Practice Address - Phone:407-303-6729
Practice Address - Fax:407-628-2037
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR137342084N0400X
FLME1259442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology