Healthcare Provider Details

I. General information

NPI: 1245605427
Provider Name (Legal Business Name): AMARILYS SANTIAGO LIC 3078
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CARR 31 # KM
JUNCOS PR
00777-3868
US

IV. Provider business mailing address

PO BOX 99
SAN LORENZO PR
00754-0099
US

V. Phone/Fax

Practice location:
  • Phone: 787-679-6569
  • Fax:
Mailing address:
  • Phone: 787-800-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3078
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: