MEDICARE: JACQUELINE SUSANA SANTANA

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	235Z00000X	Speech-Language Pathologist	SZ8842	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	:	1942784707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SUSANA SANTANA

Provider Business Mailing Address
First Line	:	9041 SW 122ND AVE APT 304
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-2014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6840 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3762
Country	:	US
Telephone Number	:	305-461-4702
Fax Number	:

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

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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Directions to “ JACQUELINE SUSANA SANTANA ” Practice Location

Language	Start Address	Practice Location

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