Healthcare Provider Details

I. General information

NPI: 1114658135
Provider Name (Legal Business Name): NATASHA LEE SANTIAGO GONZALEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KM HM 7.3 CARR 153 PLAZA SANTA ISABEL LOCAL 10-B BO. JAUCA II
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 939-222-7598
  • Fax:
Mailing address:
  • Phone: 787-831-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8572
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: