MEDICARE: LOURDES 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	106S00000X	Behavior Technician	24-394259	FL

General Provider Information

NPI Number	:	1558179671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES SANTIAGO

Provider Business Mailing Address
First Line	:	2715 SW 9TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4197
Country	:	US
Telephone Number	:	954-540-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 BARKLEY CIR STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7517
Country	:	US
Telephone Number	:	954-540-8483
Fax Number	:

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

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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Directions to “ LOURDES SANTIAGO ” Practice Location

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