Provider Demographics
NPI:1285736421
Name:SANTAELLA, IDALIA MARGARITA (MD)
Entity type:Individual
Prefix:DR
First Name:IDALIA
Middle Name:MARGARITA
Last Name:SANTAELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140878
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114
Mailing Address - Country:US
Mailing Address - Phone:305-448-7213
Mailing Address - Fax:305-448-9282
Practice Address - Street 1:137 SAN LORENZO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1524
Practice Address - Country:US
Practice Address - Phone:305-448-7213
Practice Address - Fax:305-448-9282
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44084208D00000X, 207SM0001X, 207ZP0101X, 207ZP0102X, 207ZC0500X, 207ZP0007X, 2085U0001X, 246RH0600X, 246RM2200X, 246R00000X
FL800001421246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No246RH0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyHistology
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10D0280390OtherCLIA NUMBER
FL94276Medicare ID - Type Unspecified
FL10L0008378Medicare ID - Type Unspecified
D27783Medicare UPIN