MEDICARE: SYLVIA SANTANA PA

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	261QD0000X	Dental Clinic/Center	DN19864	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821462029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLVIA SANTANA PA

Provider Business Mailing Address
First Line	:	11300 NW 87TH CT STE 166
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4521
Country	:	US
Telephone Number	:	305-364-9322
Fax Number	:	305-364-0983

Provider Business Practice Location Address
First Line	:	11300 NW 87TH CT STE 166
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4521
Country	:	US
Telephone Number	:	305-364-9322
Fax Number	:	305-364-0983

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SYLVIA SANTANA
Credential	:	DMD
Telephone Number	:	305-364-9322

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	11/25/2015

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Directions to “SYLVIA SANTANA PA ” Practice Location

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