Provider Demographics
NPI:1164014619
Name:SANTIAGO, YAIZA MARIE
Entity Type:Individual
Prefix:
First Name:YAIZA
Middle Name:MARIE
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 1:416 CALLE DAGUAO APT 904
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7860
Mailing Address - Country:US
Mailing Address - Phone:787-344-4262
Mailing Address - Fax:
Practice Address - Street 1:416 CALLE DAGUAO APT 904
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7860
Practice Address - Country:US
Practice Address - Phone:787-344-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist