Healthcare Provider Details

I. General information

NPI: 1861846677
Provider Name (Legal Business Name): YARITZA SANTIAGO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

IV. Provider business mailing address

PO BOX 936502
MARGATE FL
33093-6502
US

V. Phone/Fax

Practice location:
  • Phone: 734-588-9323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9423876
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95007784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: