Provider Demographics
NPI:1568282119
Name:SANTIAGO FIGUEROA, ANSE EDGARDO
Entity type:Individual
Prefix:
First Name:ANSE
Middle Name:EDGARDO
Last Name:SANTIAGO FIGUEROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SW 27TH PL APT 3115
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1126
Mailing Address - Country:US
Mailing Address - Phone:787-243-6773
Mailing Address - Fax:
Practice Address - Street 1:7300 SW 27TH PL APT 3115
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1126
Practice Address - Country:US
Practice Address - Phone:787-243-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6901025390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program