Healthcare Provider Details

I. General information

NPI: 1861435166
Provider Name (Legal Business Name): NIURKA MARIBEL SANTANA PHD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4399 N NOB HILL RD
SUNRISE FL
33351-5813
US

IV. Provider business mailing address

PO BOX 278696
MIRAMAR FL
33027-8696
US

V. Phone/Fax

Practice location:
  • Phone: 786-277-3100
  • Fax: 954-499-4568
Mailing address:
  • Phone: 786-277-3100
  • Fax: 954-499-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: