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NPI Code Detail

MEDICARE: MR. JIMMY SANTANA P.A. - C

MEDICARE: MR. JIMMY SANTANA P.A. - C
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
1363A00000XPhysician AssistantPA 9101221FL

General Provider Information

NPI Number : 1528278124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JIMMY SANTANA P.A. - C
Provider Business Mailing Address
First Line : 981 SW 159TH DR
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33027-5022
Country : US
Telephone Number : 305-237-4282
Fax Number : 305-237-4278
Provider Business Practice Location Address
First Line : 950 NW 20TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33127-4622
Country : US
Telephone Number : 305-237-4282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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