Provider Demographics
NPI:1033461801
Name:SANTIAGO, ROXANE M (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROXANE
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3880 MURPHY CANYON RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4411
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:865 3RD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1349
Practice Address - Country:US
Practice Address - Phone:619-426-7910
Practice Address - Fax:619-426-2337
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA122396208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics