Healthcare Provider Details

I. General information

NPI: 1457437162
Provider Name (Legal Business Name): JENNIFER SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN SUITE 408
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

1860 TOWN CENTER DR SUITE 110
RESTON VA
20190
US

V. Phone/Fax

Practice location:
  • Phone: 703-719-0382
  • Fax: 703-719-9628
Mailing address:
  • Phone: 703-796-0200
  • Fax: 703-796-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0101235943
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: