Healthcare Provider Details

I. General information

NPI: 1710189485
Provider Name (Legal Business Name): MARITZA SANTIAGO CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 CALLE MUNOZ RIVERA
PENUELAS PR
00624-1401
US

IV. Provider business mailing address

HC 8 BOX 247 BO MARUENO
PONCE PR
00731-9704
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-2173
  • Fax: 787-836-6102
Mailing address:
  • Phone: 787-290-0418
  • Fax: 787-836-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2998
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: