Healthcare Provider Details

I. General information

NPI: 1356253298
Provider Name (Legal Business Name): KATIA MARIE PEDRAZA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SECTOR CUESTA LOS LOBOS
HUMACAO PR
00791
US

IV. Provider business mailing address

REINA DE LOS ANGELES Q-13 CALLE 10 E
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-3978
  • Fax:
Mailing address:
  • Phone: 939-642-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8236
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: