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General NPI Number Information
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NPI Number | 1659183523
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Entity Type | Individual
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Provider Name | MARIAH SANTIAGO
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 518 SW PRIMA VISTA BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-8734
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Country | US
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Telephone | 772-873-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 4435 BELLE GROVE DR
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City | FORT PIERCE
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State | FL
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Zip | 34981-5081
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Country | US
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Telephone | 772-979-6783
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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