Healthcare Provider Details

I. General information

NPI: 1760958516
Provider Name (Legal Business Name): JOSHUA NOBLE-SANTIAGO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ITURREGUI PLAZA SHOPPING CENTER SUITE 17 AVENIDA 65 INFANTERIA 1135
RIO PIEDRAS PR
00924
US

IV. Provider business mailing address

ITURREGUI PLAZA SHOPPING CENTER SUITE 17 AVENIDA 65 INFANTERIA 1135
RIO PIEDRAS PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-7100
  • Fax: 787-758-8936
Mailing address:
  • Phone: 787-769-7100
  • Fax: 787-758-8936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13259
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: