Healthcare Provider Details

I. General information

NPI: 1699441550
Provider Name (Legal Business Name): ELIDOMI E. SANTANA-NUNEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 S LE JEUNE RD STE 203
CORAL GABLES FL
33134-5840
US

IV. Provider business mailing address

11005 SW 88TH ST APT C210
MIAMI FL
33176-1203
US

V. Phone/Fax

Practice location:
  • Phone: 305-672-8559
  • Fax: 305-672-9259
Mailing address:
  • Phone: 201-913-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121540
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00641000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: