Healthcare Provider Details

I. General information

NPI: 1265053847
Provider Name (Legal Business Name): LIANETTE MARIE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. FRAGOSO 4 ES 5 VILLA FONTANA, NIVEL 1
CAROLINA PR
00983
US

IV. Provider business mailing address

URB. COUNTRY CLUB CALLE 510 OM-9
CAROLINA PR
00982-1907
US

V. Phone/Fax

Practice location:
  • Phone: 787-422-2474
  • Fax:
Mailing address:
  • Phone: 787-564-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4802
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: