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General NPI Number Information
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NPI Number | 1831477702
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Entity Type | Individual
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Provider Name | VIVIANNE M SANTIAGO
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | COND. EL CENTRO OFICIE 248
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City | SAN JUAN
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State | PR
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Zip | 00918-5200
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Country | US
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Telephone | 787-432-9048
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE DURAZNOS 702 URB. PUERTO NUEVO
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City | SAN JUAN
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State | PR
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Zip | 00920-4516
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Country | US
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Telephone | 787-432-9048
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4653
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4046
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License Number State | PR
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