Organization
SANTA ROSA DE LIMA MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANTIAGO W. CALDERON M.D. (PRESIDENT)
(407) 268-5415
Entity
Organization
Contact information
Practice address
1055 SAXON BLVD, ORANGE CITY, FL 32763-8468
(407) 268-5415
Mailing address
4916 SAN MARINO CIR, C/O S. CALDERON, MD, LAKE MARY, FL 32746-2608
(407) 268-5415
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME70874
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000830802
HUMANA
FL
01
—
13935
FL MEMORIAL HEALTH NETWOR
FL
01
—
150170
HEALTHEASE
FL
05
—
263393100
—
FL
01
—
94709
BC/BS
FL
01
—
CH6285
RR MEDICARE
FL
Enumeration date
04/20/2006
Last updated
11/27/2008
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