MEDICARE: MRS. DIANA L SANTIAGO M.ED.

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	103T00000X	Psychologist	4207	PR

General Provider Information

NPI Number	:	1467728790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA L SANTIAGO M.ED.

Provider Business Mailing Address
First Line	:	PO BOX 653
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-0653
Country	:	US
Telephone Number	:	787-617-9610
Fax Number	:	787-837-7610

Provider Business Practice Location Address
First Line	:	ESTANCIAS DE JUANA DIAZ CALLE CYPRES B22
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795
Country	:	US
Telephone Number	:	787-617-9610
Fax Number	:	787-837-7610

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

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/30/2012

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