Healthcare Provider Details

I. General information

NPI: 1790336717
Provider Name (Legal Business Name): IVETTE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESTANCIAS DE GRAN VISTA 62 CALLE SAN LUIS
GURABO PR
00778
US

IV. Provider business mailing address

ESTANCIAS DE GRAN VISTA 62 CALLE SAN LUIS
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-627-9575
  • Fax:
Mailing address:
  • Phone: 787-627-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: