Provider Demographics
NPI:1063899219
Name:SANTACLARA MEDICAL SERVICES,INC
Entity type:Organization
Organization Name:SANTACLARA MEDICAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:YDANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTACLARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-261-8872
Mailing Address - Street 1:1956 MARSEILLE DR
Mailing Address - Street 2:APT # 8
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3425
Mailing Address - Country:US
Mailing Address - Phone:786-261-8872
Mailing Address - Fax:305-631-1419
Practice Address - Street 1:1956 MARSEILLE DR
Practice Address - Street 2:APT # 8
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3425
Practice Address - Country:US
Practice Address - Phone:786-261-8872
Practice Address - Fax:305-631-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIB153AOtherMEDICARE PTAN
FL013478200Medicaid