Healthcare Provider Details

I. General information

NPI: 1487430732
Provider Name (Legal Business Name): ALBERTO SANTIAGO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 SW DEL RIO BLVD
PORT SAINT LUCIE FL
34953-1967
US

IV. Provider business mailing address

1006 SW DEL RIO BLVD
PORT SAINT LUCIE FL
34953-1967
US

V. Phone/Fax

Practice location:
  • Phone: 786-322-0051
  • Fax: 772-353-5406
Mailing address:
  • Phone: 786-322-0051
  • Fax: 772-353-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: