Healthcare Provider Details

I. General information

NPI: 1104861269
Provider Name (Legal Business Name): SOILA EBERLINE GUERRERO-SANTANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 BUENAVENTURA BLVD
KISSIMMEE FL
34743-8128
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-344-9959
  • Fax: 407-344-9971
Mailing address:
  • Phone: 321-332-6947
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15318
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: