1174655419 NPI number — DR. JESSENIA SANTIAGO PSY.D.

Table of content: DR. JESSENIA SANTIAGO PSY.D. (NPI 1174655419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174655419 NPI number — DR. JESSENIA SANTIAGO PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO
Provider First Name:
JESSENIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174655419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5504 PASEO LAGO GARZAS
Provider Second Line Business Mailing Address:
EXTENSION LAGO HORIZONTE CLL
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-479-2257
Provider Business Mailing Address Fax Number:
787-845-4531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR,153 KM 7.5
Provider Second Line Business Practice Location Address:
BARRIO PASO SECO SECTOR USERAS
Provider Business Practice Location Address City Name:
SANTA ISABEL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-479-2257
Provider Business Practice Location Address Fax Number:
787-845-4531
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2696 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)