Healthcare Provider Details

I. General information

NPI: 1659001212
Provider Name (Legal Business Name): MIOSOTYS SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION ST
WEST SPRINGFIELD MA
01089-3317
US

IV. Provider business mailing address

78 LEVESQUE AVE
WEST HARTFORD CT
06110-1136
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-0040
  • Fax:
Mailing address:
  • Phone: 860-986-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: