Healthcare Provider Details

I. General information

NPI: 1295085835
Provider Name (Legal Business Name): JULIO GONZALEZ SANTANA CMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 TANNERY LN
LIBERTY ME
04949-3614
US

IV. Provider business mailing address

53 TANNERY LN
LIBERTY ME
04949-3614
US

V. Phone/Fax

Practice location:
  • Phone: 207-323-1499
  • Fax:
Mailing address:
  • Phone: 73-231-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberME
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: