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General NPI Number Information
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NPI Number | 1265821094
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Entity Type | Organization
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Legal Business Name | LOURDES T SANTIAGO M.D.P.A.
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 1305 S FORT HARRISON AVE BUILDING C
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City | CLEARWATER
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State | FL
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Zip | 33756-3301
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Country | US
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Telephone | 727-483-9188
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Fax | 727-412-8432
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Provider Business Mailing Address
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Address Line | 1305 S FORT HARRISON AVE BUILDING C
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City | CLEARWATER
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State | FL
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Zip | 33756-3301
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Country | US
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Telephone | 727-483-9188
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Fax | 727-412-8432
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Authorized Official
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Title or Position | SURGEON
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Name | DR. LOURDES SANTIAGO
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Credential |
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Telephone | 727-483-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME97611
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License Number State | FL
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