Provider Demographics
NPI:1215777339
Name:SANTACLARA MED CLINIC LLC
Entity type:Organization
Organization Name:SANTACLARA MED CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YDANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTACLARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-261-8872
Mailing Address - Street 1:8749 WEST 37 AVENUE
Mailing Address - Street 2:APT 303
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:786-261-8872
Mailing Address - Fax:
Practice Address - Street 1:1865 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4805
Practice Address - Country:US
Practice Address - Phone:786-261-8872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty