Healthcare Provider Details

I. General information

NPI: 1356122121
Provider Name (Legal Business Name): RAQUEL SANTAOLALLA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 SW 27TH AVE
MIAMI FL
33145-3664
US

IV. Provider business mailing address

850 N MIAMI AVE APT 1910
MIAMI FL
33136-3530
US

V. Phone/Fax

Practice location:
  • Phone: 786-497-3444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: