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General NPI Number Information
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NPI Number | 1932612413
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Entity Type | Individual
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Provider Name | SAMANTHA G SANTIAGO PA
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Gender | Female
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 1 CHILDRENS WAY # 707
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City | LITTLE ROCK
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State | AR
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Zip | 72202
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Country | US
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Telephone | 501-364-2914
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Fax | 501-364-1649
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Provider Business Mailing Address
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Address Line | 1 CHILDRENS WAY # 653
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3500
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Country | US
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Telephone | 501-364-1100
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Fax | 501-364-4082
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-858
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1146648
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License Number State | AZ
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