Healthcare Provider Details

I. General information

NPI: 1457775884
Provider Name (Legal Business Name): EVELYN SANTIAGO PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 4 BOX 45322
CAGUAS PR
00727-9640
US

IV. Provider business mailing address

HC 4 BOX 45322
CAGUAS PR
00727-9640
US

V. Phone/Fax

Practice location:
  • Phone: 787-612-4833
  • Fax:
Mailing address:
  • Phone: 787-612-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5593
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: