Provider Demographics
NPI:1285365684
Name:SANTANA, ALICE G
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:G
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 AMBACH WAY
Mailing Address - Street 2:
Mailing Address - City:HYPOLUXO
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6149
Mailing Address - Country:US
Mailing Address - Phone:561-806-4850
Mailing Address - Fax:
Practice Address - Street 1:8001 AMBACH WAY
Practice Address - Street 2:
Practice Address - City:HYPOLUXO
Practice Address - State:FL
Practice Address - Zip Code:33462-6149
Practice Address - Country:US
Practice Address - Phone:561-806-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty