Healthcare Provider Details

I. General information

NPI: 1578432324
Provider Name (Legal Business Name): SANTIAGO HECTOR FERREYRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W VINE ST
KISSIMMEE FL
34741-4182
US

IV. Provider business mailing address

100 PINE ISLAND CIR
KISSIMMEE FL
34743-8169
US

V. Phone/Fax

Practice location:
  • Phone: 407-494-2482
  • Fax: 321-250-7453
Mailing address:
  • Phone: 321-746-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: