Provider Demographics
NPI:1164716494
Name:SANTIAGO, MARY JANE C (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:C
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:CONVENTO
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:550 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-6221
Mailing Address - Country:US
Mailing Address - Phone:650-802-6478
Mailing Address - Fax:650-596-5162
Practice Address - Street 1:550 QUARRY RD
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-6221
Practice Address - Country:US
Practice Address - Phone:650-802-6478
Practice Address - Fax:650-596-5162
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor