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NPI Code Detail

MEDICARE: JAN MAVERICK SANTOS SANTIAGO

MEDICARE: JAN MAVERICK SANTOS 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
1164X00000XLicensed Vocational NurseVN263543CA

General Provider Information

NPI Number : 1952940462
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN MAVERICK SANTOS SANTIAGO
Provider Business Mailing Address
First Line : 1003 CONCORD ST
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-2807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1003 CONCORD ST
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-2807
Country : US
Telephone Number : 949-698-3632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2019
Last Update Date : 12/31/2019

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Directions to “ JAN MAVERICK SANTOS SANTIAGO ” Practice Location

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