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General NPI Number Information
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NPI Number | 1528889235
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Entity Type | Individual
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Provider Name | DIMARCO SANTIAGO
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Gender | Male
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 4625 E BAY DR STE 105
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City | CLEARWATER
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State | FL
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Zip | 33764-6866
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Country | US
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Telephone | 863-619-2809
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Fax |
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Provider Business Mailing Address
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Address Line | 12025 132ND AVE
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City | LARGO
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State | FL
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Zip | 33778-1417
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Country | US
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Telephone | 727-565-9291
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-387759
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License Number State | FL
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