Healthcare Provider Details

I. General information

NPI: 1902053911
Provider Name (Legal Business Name): JORGE J SANTIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12446 SW 9TH TER
MIAMI FL
33184-2601
US

IV. Provider business mailing address

12446 SW 9TH TER
MIAMI FL
33184-2601
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-6998
  • Fax:
Mailing address:
  • Phone: 305-223-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102326
License Number StateFL

VIII. Authorized Official

Name: DR. JORGE J SANTIN
Title or Position: PRESIDENT
Credential: MD
Phone: 305-223-6998