Provider Demographics
NPI:1871279059
Name:SANTANA, JESSY CARIDAD
Entity type:Individual
Prefix:
First Name:JESSY
Middle Name:CARIDAD
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 1:230 SALAMANCA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3948
Mailing Address - Country:US
Mailing Address - Phone:786-239-1333
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST STE 204
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5922
Practice Address - Country:US
Practice Address - Phone:305-406-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-277337106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician