Healthcare Provider Details

I. General information

NPI: 1346448677
Provider Name (Legal Business Name): GELIZA IVETTE SANTIAGO MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G2 CALLE JADE URB. LA MILAGROSA
SABANA GRANDE PR
00637-2010
US

IV. Provider business mailing address

G2 CALLE JADE URB. LA MILAGROSA
SABANA GRANDE PR
00637-2010
US

V. Phone/Fax

Practice location:
  • Phone: 787-873-5081
  • Fax:
Mailing address:
  • Phone: 787-873-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number6732
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: