Provider Demographics
NPI:1104132000
Name:RICARDO SANTAYANA MD PA
Entity type:Organization
Organization Name:RICARDO SANTAYANA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAYANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-932-7303
Mailing Address - Street 1:3201 W WATERS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2879
Mailing Address - Country:US
Mailing Address - Phone:813-932-7303
Mailing Address - Fax:813-932-1923
Practice Address - Street 1:3201 W WATERS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2879
Practice Address - Country:US
Practice Address - Phone:813-932-7303
Practice Address - Fax:813-932-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL695190Medicaid
FLD58950Medicare UPIN
79848Medicare PIN