Healthcare Provider Details

I. General information

NPI: 1699788877
Provider Name (Legal Business Name): ESTEBANIA SANTIAGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE.65TH INF. CAROLINA SHOPPING COURT 6TH FLOOR OF.303
CAROLINA PR
00985
US

IV. Provider business mailing address

ST.8 #L-3 VILLAS DE LOIZA
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-1954
  • Fax: 787-752-4303
Mailing address:
  • Phone: 787-876-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number000184
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: