Healthcare Provider Details

I. General information

NPI: 1144690926
Provider Name (Legal Business Name): ANTONIO MILLAND SANTIAGO MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 BENT PINE DR APT 624B
ORLANDO FL
32822-4977
US

IV. Provider business mailing address

6237 BENT PINE DR APT 624B
ORLANDO FL
32822-4977
US

V. Phone/Fax

Practice location:
  • Phone: 407-432-9708
  • Fax:
Mailing address:
  • Phone: 407-432-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09789
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: