Provider Demographics
NPI:1063276707
Name:SANTANA, ANDRES ROBERTO (LMT)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:ROBERTO
Last Name:SANTANA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 GATOR DR APT 427
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-2204
Mailing Address - Country:US
Mailing Address - Phone:407-269-9982
Mailing Address - Fax:
Practice Address - Street 1:2233 GATOR DR APT 427
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-2204
Practice Address - Country:US
Practice Address - Phone:407-269-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist