Basic Information
| Provider Information | |||||||||
| NPI: | 1992324099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTANA ALCANTARA | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | ENERIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14621 SW 158TH PL | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331966778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862539451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1276 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185901800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | P102961 | NY | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 1992324099 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.