Healthcare Provider Details

I. General information

NPI: 1285538017
Provider Name (Legal Business Name): CORALY SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 20 BOX 25502
SAN LORENZO PR
00754-9472
US

IV. Provider business mailing address

HC 20 BOX 25502
SAN LORENZO PR
00754-9472
US

V. Phone/Fax

Practice location:
  • Phone: 787-242-8931
  • Fax:
Mailing address:
  • Phone: 787-242-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1055
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: