Healthcare Provider Details

I. General information

NPI: 1154430478
Provider Name (Legal Business Name): MARIA VIRGEN SANTIAGO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/22/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE EL JIBARO CARR 172 KM 13.5 BO BAYAMON
CIDRA PR
00739
US

IV. Provider business mailing address

BO. RABANAL RR-01 BUZON 2407
CIDRA PR
00739-2407
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax: 787-739-8190
Mailing address:
  • Phone: 787-263-8470
  • Fax: 787-739-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2695
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: