Healthcare Provider Details

I. General information

NPI: 1174719058
Provider Name (Legal Business Name): CECILIA SANTIAGO CARIGMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18821 PIONEER BLVD SUITE D
CERRITOS CA
90701-5667
US

IV. Provider business mailing address

20826 ELY AVE
LAKEWOOD CA
90715-1665
US

V. Phone/Fax

Practice location:
  • Phone: 562-403-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: