Healthcare Provider Details

I. General information

NPI: 1225340896
Provider Name (Legal Business Name): WALESKA SANTIAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13845 AMBERLEIGH RD
ORLANDO FL
32837-8023
US

IV. Provider business mailing address

13845 AMBERLEIGH RD
ORLANDO FL
32837-8023
US

V. Phone/Fax

Practice location:
  • Phone: 215-470-4686
  • Fax:
Mailing address:
  • Phone: 215-470-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME133565
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number313017
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number17953
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD444903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: