Provider Demographics
NPI:1629960109
Name:CUTINO SANTANA, MIRELIS (PH1)
Entity type:Individual
Prefix:
First Name:MIRELIS
Middle Name:
Last Name:CUTINO SANTANA
Suffix:
Gender:F
Credentials:PH1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-7338
Mailing Address - Country:US
Mailing Address - Phone:863-347-0119
Mailing Address - Fax:
Practice Address - Street 1:226 N CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-7338
Practice Address - Country:US
Practice Address - Phone:863-347-0119
Practice Address - Fax:941-827-4700
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55610050246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy