Healthcare Provider Details

I. General information

NPI: 1609367580
Provider Name (Legal Business Name): VIVIANA RUBIO SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10611 W 33RD CT
HIALEAH FL
33018-2116
US

IV. Provider business mailing address

10611 W 33RD CT
HIALEAH FL
33018-2116
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-7277
  • Fax:
Mailing address:
  • Phone: 305-742-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCCM100334
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: