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General NPI Number Information
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NPI Number | 1265075758
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Entity Type | Individual
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Provider Name | AMANDA SANTIAGO MATIAS
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | HOSPITAL PSIQUIATRICO FORENSE CALLE CESAR TENIENTE 1106 CENTRO MEDICO
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City | RIO PIEDRAS
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State | PR
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Zip | 00960-7087
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Country | US
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Telephone | 787-478-9519
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Fax |
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Provider Business Mailing Address
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Address Line | HOSPITAL PSIQUIATRICO FORENSE CALLE CESAR TENIENTE 1106 CENTRO MEDICO
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City | RIO PIEDRAS
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State | PR
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Zip | 00928
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Country | US
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Telephone | 787-478-9519
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13929
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License Number State | PR
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