Healthcare Provider Details

I. General information

NPI: 1174614044
Provider Name (Legal Business Name): ANTHONY D SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LINCOLN WAY
AMES IA
50010-3309
US

IV. Provider business mailing address

1200 VALLEY WEST DR SUITE 707
WEST DES MOINES IA
50266-1908
US

V. Phone/Fax

Practice location:
  • Phone: 515-233-1122
  • Fax: 515-233-6500
Mailing address:
  • Phone: 515-222-1999
  • Fax: 515-224-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00216
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: