Healthcare Provider Details

I. General information

NPI: 1093805723
Provider Name (Legal Business Name): JESSICA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 CALLE LUIS MUNOZ RIVERA
GUAYANILLA PR
00656-1814
US

IV. Provider business mailing address

PO BOX 1064
YAUCO PR
00698-1064
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-2840
  • Fax:
Mailing address:
  • Phone: 787-856-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4511
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: