Provider Demographics
NPI:1730879578
Name:SANTANA, ALEXZA JULIA
Entity type:Individual
Prefix:
First Name:ALEXZA
Middle Name:JULIA
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 POST RD E
Mailing Address - Street 2:STE 3 PMB 651
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4540
Mailing Address - Country:US
Mailing Address - Phone:516-362-0440
Mailing Address - Fax:
Practice Address - Street 1:224 W 35TH ST FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2533
Practice Address - Country:US
Practice Address - Phone:929-266-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY890021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist