Healthcare Provider Details

I. General information

NPI: 1851338453
Provider Name (Legal Business Name): JOAQUIN SANTOLAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOAQUIN SANTOLAYA-FORGAS MD

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100294
GAINESVILLE FL
32610-1962
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100294
GAINESVILLE FL
32610-0294
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7580
  • Fax:
Mailing address:
  • Phone: 352-273-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License NumberME132311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: