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General NPI Number Information
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NPI Number | 1104568062
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Entity Type | Individual
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Provider Name | LOURDES M SANTIAGO PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 433 SOSCOL AVE STE B191
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City | NAPA
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State | CA
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Zip | 94559-4040
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Country | US
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Telephone | 707-900-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 GARDEN AVE
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City | SAINT HELENA
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State | CA
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Zip | 94574-1503
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Country | US
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Telephone | 170-770-4971
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT294030
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License Number State | CA
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