MEDICARE: RAMON VIANZON SANTA MARIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME57360	FL

General Provider Information

NPI Number	:	1417091844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON VIANZON SANTA MARIA M.D.

Provider Business Mailing Address
First Line	:	4051 UPPER CREEK DR
Second Line	:	SUITE 110
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6825
Country	:	US
Telephone Number	:	813-633-2504
Fax Number	:	813-633-2546

Provider Business Practice Location Address
First Line	:	4051 UPPER CREEK DR
Second Line	:	SUITE 110
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6825
Country	:	US
Telephone Number	:	813-633-2504
Fax Number	:	813-633-2546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2007
Last Update Date	:	07/08/2007

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