Healthcare Provider Details

I. General information

NPI: 1306922943
Provider Name (Legal Business Name): MRS. MARIA I. SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 BROOK ST BLDG 21
FORT BUCHANAN PR
00934-4206
US

IV. Provider business mailing address

HC 3 BOX 20250
LAJAS PR
00667-9502
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-2178
  • Fax:
Mailing address:
  • Phone: 787-808-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number000146
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: