Healthcare Provider Details

I. General information

NPI: 1720230634
Provider Name (Legal Business Name): ANA JEANNETTE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NE NORTH MIAMI BLVD STE 1
NORTH MIAMI FL
33161-5718
US

IV. Provider business mailing address

901 NE NORTH MIAMI BLVD STE 1
NORTH MIAMI FL
33161-5718
US

V. Phone/Fax

Practice location:
  • Phone: 305-919-7399
  • Fax: 305-919-7424
Mailing address:
  • Phone: 305-919-7399
  • Fax: 305-919-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT82562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: