Provider Demographics
NPI:1992964878
Name:PLANTATION MEDICAL AND SURGICAL PA
Entity type:Organization
Organization Name:PLANTATION MEDICAL AND SURGICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRIANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-494-0829
Mailing Address - Street 1:357 JACARANDA DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3009
Mailing Address - Country:US
Mailing Address - Phone:954-494-0829
Mailing Address - Fax:
Practice Address - Street 1:817 S UNIVERSITY DR STE 105
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3345
Practice Address - Country:US
Practice Address - Phone:954-494-0829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23915208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71946WMedicare PIN