MEDICARE: SARA NICOLE SANTIAGO

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
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316371727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA NICOLE SANTIAGO

Provider Business Mailing Address
First Line	:	3800 DALECREST DR UNIT 1054
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1762
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 DALECREST DR UNIT 1054
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1762
Country	:	US
Telephone Number	:	702-541-2567
Fax Number	:	702-541-2567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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Directions to “ SARA NICOLE SANTIAGO ” Practice Location

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