Provider Demographics
NPI:1144789561
Name:SANTIAGO, MARCIA (CDN, IBCLC, CD(DONA))
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CDN, IBCLC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 VICTORY BLVD APT 4E
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3734
Mailing Address - Country:US
Mailing Address - Phone:347-744-0766
Mailing Address - Fax:
Practice Address - Street 1:937 VICTORY BLVD APT 4E
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3734
Practice Address - Country:US
Practice Address - Phone:347-744-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 174N00000X, 374J00000X
NY010734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty