Healthcare Provider Details

I. General information

NPI: 1295432706
Provider Name (Legal Business Name): YUMNARY GATO SANTIESTEBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 S CLEVELAND AVE STE 15A
FORT MYERS FL
33907-1371
US

IV. Provider business mailing address

5439 USEPPA DR
AVE MARIA FL
34142-5078
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-7411
  • Fax:
Mailing address:
  • Phone: 239-601-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME181664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: