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General NPI Number Information
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NPI Number | 1548496474
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Entity Type | Individual
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Provider Name | WILHELMINA MATIENZO SANTIAGO M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 7410 DELAWARE LN UPPR LEVEL
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City | VANCOUVER
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State | WA
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Zip | 98664-1408
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Country | US
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Telephone | 360-566-4402
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Fax | 360-566-4406
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Provider Business Mailing Address
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Address Line | PO BOX 34703
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City | SEATTLE
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State | WA
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Zip | 98124-1703
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Country | US
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Telephone | 360-566-4402
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Fax | 915-577-9315
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P5235
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License Number State | TX
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