Individual
TEOFILO ENRIQUE MATOS SANTANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4175 W 20TH AVE, HIALEAH, FL 33012-5874
(305) 424-3118
Mailing address
4175 W 20TH AVE, HIALEAH, FL 33012-5874
(305) 424-3118
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
052182
CT
2084P0800X
Psychiatry Physician
Primary
ME161306
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/11/2011
Last updated
09/16/2024
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