Healthcare Provider Details

I. General information

NPI: 1922491208
Provider Name (Legal Business Name): MARTA OLIVERAS SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SANTURCE PR
00909-2538
US

IV. Provider business mailing address

759 AVE VICENTE
SANTURCE PUERTO RICO
00909
UM

V. Phone/Fax

Practice location:
  • Phone: 787-303-9662
  • Fax: 787-724-5559
Mailing address:
  • Phone: 787-303-9662
  • Fax: 787-724-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1862-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: