Provider Demographics
NPI:1912611203
Name:SANTA, ODALIS JULIA (LMHC, RN)
Entity Type:Individual
Prefix:
First Name:ODALIS
Middle Name:JULIA
Last Name:SANTA
Suffix:
Gender:F
Credentials:LMHC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2255
Mailing Address - Country:US
Mailing Address - Phone:786-804-3074
Mailing Address - Fax:
Practice Address - Street 1:7435 BAY HILL DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2255
Practice Address - Country:US
Practice Address - Phone:786-804-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9615792163WC0400X, 163WG0000X
FLMH4731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice