Provider Demographics
NPI:1417791674
Name:IN AFFECTUM LLC
Entity type:Organization
Organization Name:IN AFFECTUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:407-269-9982
Mailing Address - Street 1:2233 GATOR DR APT 427
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-2204
Mailing Address - Country:US
Mailing Address - Phone:407-269-9982
Mailing Address - Fax:
Practice Address - Street 1:1010 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2827
Practice Address - Country:US
Practice Address - Phone:407-269-9982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty