Healthcare Provider Details

I. General information

NPI: 1588433155
Provider Name (Legal Business Name): MARIA CONCEPCION SANTIAGO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 QUEENS BLVD 2ND FLOOR, SUITE A
REGO PARK NY
11374-4510
US

IV. Provider business mailing address

4012 165TH ST APT 1
FLUSHING NY
11358-2771
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-5280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: