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NPI Code Detail

MEDICARE: IRMA DE SANTIAGO MS, LMFT

MEDICARE: IRMA DE SANTIAGO MS, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist4705NV

General Provider Information

NPI Number : 1073055380
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRMA DE SANTIAGO MS, LMFT
Provider Business Mailing Address
First Line : 4528 STARDUSK FALLS AVE
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89084-4723
Country : US
Telephone Number : 702-518-6608
Fax Number :
Provider Business Practice Location Address
First Line : 7465 W LAKE MEAD BLVD STE 225
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-1033
Country : US
Telephone Number : 702-518-6608
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2016
Last Update Date : 06/16/2026

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