Healthcare Provider Details

I. General information

NPI: 1518325885
Provider Name (Legal Business Name): YVONNE SANTIAGO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 N RIVERSIDE AVE
RIALTO CA
92377-4696
US

IV. Provider business mailing address

2006 N RIVERSIDE AVE
RIALTO CA
92377-4696
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-2999
  • Fax: 909-883-2997
Mailing address:
  • Phone: 909-883-2999
  • Fax: 909-883-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: