Healthcare Provider Details

I. General information

NPI: 1376383497
Provider Name (Legal Business Name): JANID MILAGROS SANTIAGO MS PHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2963
CAROLINA PR
00984-2963
US

IV. Provider business mailing address

PO BOX 2963
CAROLINA PR
00984-2963
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax:
Mailing address:
  • Phone: 787-276-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4504
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: