Healthcare Provider Details

I. General information

NPI: 1629530936
Provider Name (Legal Business Name): ERICK ENERIO SANTANA ALCANTARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 DYER BLVD
KISSIMMEE FL
34741-7839
US

IV. Provider business mailing address

3070 DYER BLVD
KISSIMMEE FL
34741-7839
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-7930
  • Fax: 321-203-4655
Mailing address:
  • Phone: 407-932-7930
  • Fax: 321-203-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME154567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: