MEDICARE: TERRY JOAN SANTIAGO NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	NP14831	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01080865	OTHER	CA	RR MEDICARE - SO CALIF

General Provider Information

NPI Number	:	1659410991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY JOAN SANTIAGO NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2285 CORPORATE CIR
Second Line	:	STE 200
City	:	HENDERSON
State	:	NV
Zip	:	89074-7759
Country	:	US
Telephone Number	:	702-360-2763
Fax Number	:	949-783-2880

Provider Business Practice Location Address
First Line	:	4244 RIVERWALK PKWY
Second Line	:	SUITE 170
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-8509
Country	:	US
Telephone Number	:	951-736-7432
Fax Number	:	951-736-7751

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	03/16/2016

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Directions to “ TERRY JOAN SANTIAGO NURSE PRACTITIONER” Practice Location

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