MEDICARE: J.A SANTIAGO, MS, RPT, P.A

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1659693240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.A SANTIAGO, MS, RPT, P.A

Provider Business Mailing Address
First Line	:	1704 W DR MLK JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6508
Country	:	US
Telephone Number	:	813-876-7400
Fax Number	:	813-877-8145

Provider Business Practice Location Address
First Line	:	1704 W DR MLK JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6508
Country	:	US
Telephone Number	:	813-876-7400
Fax Number	:	813-877-8145

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE A SANTIAGO
Credential	:	MS, RPT, P.A
Telephone Number	:	813-876-7400

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	10/15/2010

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