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General NPI Number Information
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NPI Number | 1508271925
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Entity Type | Organization
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Legal Business Name | WALESKA SANTIAGO, PC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 1 BROWN STREET UNIT 1414
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City | PHILADELPHIA
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State | PA
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Zip | 19123
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Country | US
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Telephone | 215-470-4828
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROWN STREET UNIT 1414
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City | PHILADELPHIA
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State | PA
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Zip | 19123
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Country | US
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Telephone | 215-470-4828
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALESKA SANTIAGO
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Credential | M.D.
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Telephone | 215-470-4686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD444903
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License Number State | PA
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