Healthcare Provider Details

I. General information

NPI: 1194303081
Provider Name (Legal Business Name): SILVIA MARIA SANTIAGO MORALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SILVIA SANTIAGO SILVIA SANTIAGO, MD

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-0322
  • Fax:
Mailing address:
  • Phone: 505-955-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2024-0869
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: