Healthcare Provider Details

I. General information

NPI: 1902449069
Provider Name (Legal Business Name): MIRANDA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DISTRICT CENTER DR
PALM SPRINGS CA
92264-3626
US

IV. Provider business mailing address

150 DISTRICT CENTER DR
PALM SPRINGS CA
92264-3626
US

V. Phone/Fax

Practice location:
  • Phone: 760-251-1551
  • Fax:
Mailing address:
  • Phone: 760-251-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberASW134359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: