Provider Demographics
NPI:1114658135
Name:SANTIAGO GONZALEZ, NATASHA LEE (STUDENT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LEE
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:LEE
Other - Last Name:SANTIAGO GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STUDENT
Mailing Address - Street 1:388 ZONA IND REPARADA 2
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2347
Mailing Address - Country:US
Mailing Address - Phone:787-840-2575
Mailing Address - Fax:
Practice Address - Street 1:388 ZONA IND REPARADA 2
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2347
Practice Address - Country:US
Practice Address - Phone:787-840-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6264304OtherSTUDENT