Provider Demographics
NPI:1174761662
Name:SIFRE, SANTIAGO G (AP/DOM)
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:G
Last Name:SIFRE
Suffix:
Gender:M
Credentials:AP/DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3641
Mailing Address - Country:US
Mailing Address - Phone:305-672-4403
Mailing Address - Fax:
Practice Address - Street 1:333 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 710
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3641
Practice Address - Country:US
Practice Address - Phone:305-672-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP875171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651260591OtherFEI NUMBER