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General NPI Number Information
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NPI Number | 1528538063
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Entity Type | Individual
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Provider Name | TANIA SANTIAGO-GREATHOUSE
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Gender | Female
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 790 E BOULDER CREEK LN
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City | FRESNO
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State | CA
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Zip | 93730-1237
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Country | US
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Telephone | 559-790-4275
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Fax |
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Provider Business Mailing Address
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Address Line | 790 E BOULDER CREEK LN
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City | FRESNO
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State | CA
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Zip | 93730-1237
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Country | US
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Telephone | 559-790-4275
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | D2990017
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License Number State | CA
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