Basic Information
| Provider Information | |||||||||
| NPI: | 1639270549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTIAGO-TORRES | ||||||||
| FirstName: | JOHANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 TAVISTOCK LAKES BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328277592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213326947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 S DIXIE DR | ||||||||
| Address2: | |||||||||
| City: | HAINES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338442844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634211190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN1455 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 16444 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.