Healthcare Provider Details

I. General information

NPI: 1306384748
Provider Name (Legal Business Name): DORCAS SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 ZIRCON DR SW UNIT C6
LAKEWOOD WA
98498-4003
US

IV. Provider business mailing address

8605 ZIRCON DR SW UNIT C6
LAKEWOOD WA
98498-4003
US

V. Phone/Fax

Practice location:
  • Phone: 787-219-1373
  • Fax:
Mailing address:
  • Phone: 787-219-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number9110
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: