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General NPI Number Information
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NPI Number | 1164729893
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Entity Type | Individual
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Provider Name | ELSA SANTANA MED
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Gender | Female
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 4898 E IRLO BRONSON HWY., 2ND FLOOR ST. CLOUD FL 34744
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City | ST. CLOUD
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State | FL
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Zip | 34744
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Country | US
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Telephone | 407-891-3054
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Fax | 888-477-7678
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Provider Business Mailing Address
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Address Line | 4898 E IRLO BRONSON HWY., 2ND FLOOR ST. CLOUD FL 34744
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City | ST. CLOUD
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State | FL
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Zip | 34744
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Country | US
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Telephone | 407-891-3054
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Fax | 888-477-7678
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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