Healthcare Provider Details

I. General information

NPI: 1134036676
Provider Name (Legal Business Name): MRS. LUANNA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7524 GRAND CENTRAL PKWY
FOREST HILLS NY
11375-5557
US

IV. Provider business mailing address

12007 85TH AVE APT 3B
KEW GARDENS NY
11415-3218
US

V. Phone/Fax

Practice location:
  • Phone: 718-268-3444
  • Fax:
Mailing address:
  • Phone: 347-989-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number723387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: