Provider Demographics
NPI:1902549629
Name:ALAMEDA, SANTIAGO
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:ALAMEDA
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 1:2775 W OKEECHOBEE RD LOT C17
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1059
Mailing Address - Country:US
Mailing Address - Phone:786-444-2539
Mailing Address - Fax:
Practice Address - Street 1:2775 W OKEECHOBEE RD LOT C17
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1059
Practice Address - Country:US
Practice Address - Phone:786-444-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884704Medicaid