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NPI Code Detail

MEDICARE: RYAN JAMES SANTIAGO

MEDICARE: RYAN JAMES 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1790610004
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN JAMES SANTIAGO
Provider Business Mailing Address
First Line : 12658 N 150TH LN
Second Line :
City : SURPRISE
State : AZ
Zip : 85379-6916
Country : US
Telephone Number : 619-767-8826
Fax Number :
Provider Business Practice Location Address
First Line : 19555 N 59TH AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-6813
Country : US
Telephone Number : 623-572-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2026
Last Update Date : 06/17/2026

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Directions to “ RYAN JAMES SANTIAGO ” Practice Location

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