Healthcare Provider Details

I. General information

NPI: 1285736421
Provider Name (Legal Business Name): IDALIA MARGARITA SANTAELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SAN LORENZO AVE SUITE 100
CORAL GABLES FL
33146-1524
US

IV. Provider business mailing address

PO BOX 140878
CORAL GABLES FL
33114
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-7213
  • Fax: 305-448-9282
Mailing address:
  • Phone: 305-448-7213
  • Fax: 305-448-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME44084
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207SM0001X
TaxonomyMolecular Genetic Pathology (Medical Genetics) Physician
License NumberME44084
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME44084
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME44084
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number800001421
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME44084
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberME44084
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME44084
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code246RH0600X
TaxonomyHistology Technician
License NumberME44084
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberME44084
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code246R00000X
TaxonomyPathology Technician
License NumberME44084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: