Healthcare Provider Details

I. General information

NPI: 1225964109
Provider Name (Legal Business Name): SANTA ANA MEDICAL RESEARCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE STE 104
HIALEAH FL
33012-4645
US

IV. Provider business mailing address

3750 W 16TH AVE STE 104
HIALEAH FL
33012-4645
US

V. Phone/Fax

Practice location:
  • Phone: 786-396-1053
  • Fax: 786-396-1054
Mailing address:
  • Phone: 786-396-1053
  • Fax: 786-396-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEYVIS S FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-396-1053