Provider Demographics
NPI:1427046978
Name:MESORANA, SANTIAGO (MD)
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:MESORANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANTIAGO
Other - Middle Name:
Other - Last Name:MESORANA-TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1613 N HARRISON PARKWAY
Mailing Address - Street 2:#200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2853
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1758
Practice Address - Street 1:1431 SW 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-401-1000
Practice Address - Fax:352-401-1210
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056115207PE0004X
FLME56115207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370472600Medicaid
F38886Medicare UPIN
FL370472600Medicaid