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General NPI Number Information
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NPI Number | 1417004789
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Entity Type | Organization
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Legal Business Name | JORGE SANTANDER MD PA
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 4080 SW 84TH AVE STE D
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City | MIAMI
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State | FL
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Zip | 33155-4201
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Country | US
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Telephone | 305-223-1140
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Fax | 305-223-1174
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Provider Business Mailing Address
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Address Line | 4080 SW 84TH AVE STE D
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City | MIAMI
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State | FL
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Zip | 33155-4201
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Country | US
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Telephone | 305-223-1140
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Fax | 305-223-1174
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE SANTANDER
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Credential | MD
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Telephone | 305-223-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME83255
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License Number State | FL
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