Healthcare Provider Details

I. General information

NPI: 1669380184
Provider Name (Legal Business Name): MICAELA DE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22790 SW 112TH AVE
MIAMI FL
33170-7602
US

IV. Provider business mailing address

16730 SW 300TH ST
HOMESTEAD FL
33030-3435
US

V. Phone/Fax

Practice location:
  • Phone: 305-235-2616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: