Healthcare Provider Details

I. General information

NPI: 1508784885
Provider Name (Legal Business Name): LEONARDO SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 S WASHINGTON AVE
SAGINAW MI
48601-2566
US

IV. Provider business mailing address

834 S WASHINGTON AVE
SAGINAW MI
48601-2577
US

V. Phone/Fax

Practice location:
  • Phone: 989-758-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number2018048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: