Healthcare Provider Details

I. General information

NPI: 1144219874
Provider Name (Legal Business Name): SANTANA DIAGNOSTIC SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 SW 136TH AVE SUITE 212
MIAMI FL
33186-5885
US

IV. Provider business mailing address

12855 SW 136TH AVE SUITE 212
MIAMI FL
33186-5885
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-4449
  • Fax:
Mailing address:
  • Phone: 305-251-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL R DEL VALLE
Title or Position: PRESIDENT
Credential:
Phone: 305-251-4449