MEDICARE: MS. MARJOLYNE SANTIAGO SALES

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	163WE0003X	Emergency Registered Nurse	632870	CA
2	363LF0000X	Family Nurse Practitioner	95003929	CA

General Provider Information

NPI Number	:	1942661772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARJOLYNE SANTIAGO SALES

Provider Business Mailing Address
First Line	:	8638 RANCHO VISTA ST
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-4582
Country	:	US
Telephone Number	:	562-413-5760
Fax Number	:

Provider Business Practice Location Address
First Line	:	8638 RANCHO VISTA ST
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-4582
Country	:	US
Telephone Number	:	562-413-5760
Fax Number	:

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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