MEDICARE: JUSTIS SANTIAGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1083542112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIS SANTIAGO

Provider Business Mailing Address
First Line	:	148 SAINT GEORGE RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-5159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 SAINT GEORGE RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-5159
Country	:	US
Telephone Number	:	757-785-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ JUSTIS SANTIAGO ” Practice Location

Language	Start Address	Practice Location

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