Provider Demographics
NPI:1861435166
Name:SANTANA, NIURKA MARIBEL (PHD PSYD)
Entity type:Individual
Prefix:DR
First Name:NIURKA
Middle Name:MARIBEL
Last Name:SANTANA
Suffix:
Gender:F
Credentials:PHD PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278696
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-8696
Mailing Address - Country:US
Mailing Address - Phone:786-277-3100
Mailing Address - Fax:954-499-4568
Practice Address - Street 1:4399 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5813
Practice Address - Country:US
Practice Address - Phone:786-277-3100
Practice Address - Fax:954-499-4568
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6526103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3249Medicare ID - Type Unspecified
OTH000Medicare UPIN