Provider Demographics
NPI:1033714118
Name:SANTIAGO, DALI
Entity Type:Individual
Prefix:DR
First Name:DALI
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G-11 CALLE 7 ALTURAS DE STA. ISABEL
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2900
Mailing Address - Country:US
Mailing Address - Phone:787-948-2546
Mailing Address - Fax:
Practice Address - Street 1:G-11 CALLE 7 ALTURAS DE STA. ISABEL
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2900
Practice Address - Country:US
Practice Address - Phone:787-948-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist