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General NPI Number Information
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NPI Number | 1679103535
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Entity Type | Individual
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Provider Name | BERENICE DE SANTIAGO
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Gender | Female
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 5312 RIO BRAVO DR STE 10
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City | SANTA TERESA
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State | NM
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Zip | 88008-9210
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Country | US
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Telephone | 915-300-3992
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4898
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City | SUNLAND PARK
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State | NM
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Zip | 88063-4898
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Country | US
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Telephone | 915-300-3992
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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