=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952036634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN SANTIAGO-COOK ATR-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2022
-----------------------------------------------------
Last Update Date | 07/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 PATTERSON RD CFA BUILDING 110
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-433-0267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45-055 WAIKALUALOKO LOOP
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-2753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-853-3572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 221700000X
-----------------------------------------------------
Taxonomy Name | Art Therapist
-----------------------------------------------------
License Number | 17-286
-----------------------------------------------------
License Number State |
-----------------------------------------------------