Healthcare Provider Details

I. General information

NPI: 1003692765
Provider Name (Legal Business Name): VICMARIE SANTIAGO NL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA GUASABARA, CARR 798 KM 30.6
CAGUAS PR
00725
US

IV. Provider business mailing address

HC 1 BOX 5297
CIALES PR
00638-9658
US

V. Phone/Fax

Practice location:
  • Phone: 787-522-5353
  • Fax:
Mailing address:
  • Phone: 787-548-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number226
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: