Healthcare Provider Details

I. General information

NPI: 1013484021
Provider Name (Legal Business Name): JOSEAN SANTIAGO-CHAVES MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2018
Last Update Date: 10/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CALLE FELIX NIEVES NIEVES
ISABELA PR
00662-6429
US

IV. Provider business mailing address

919 CALLE FELIX NIEVES NIEVES
ISABELA PR
00662-6429
US

V. Phone/Fax

Practice location:
  • Phone: 787-560-5785
  • Fax:
Mailing address:
  • Phone: 787-560-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13269
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: