Provider Demographics
NPI:1629530936
Name:SANTANA ALCANTARA, ERICK ENERIO (MD)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:ENERIO
Last Name:SANTANA ALCANTARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 DYER BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7839
Mailing Address - Country:US
Mailing Address - Phone:407-932-7930
Mailing Address - Fax:321-203-4655
Practice Address - Street 1:3070 DYER BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7839
Practice Address - Country:US
Practice Address - Phone:407-932-7930
Practice Address - Fax:321-203-4655
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME154567208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115310100Medicaid