MEDICARE: VICMAR SANTIAGO

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1841596780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICMAR SANTIAGO

Provider Business Mailing Address
First Line	:	1257 SW 46TH AVE
Second Line	:	#1809
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-6440
Country	:	US
Telephone Number	:	954-756-5920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 SW 46TH AVE
Second Line	:	#1809
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-6440
Country	:	US
Telephone Number	:	954-756-5920
Fax Number	:

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	02/09/2011

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Directions to “ VICMAR SANTIAGO ” Practice Location

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