Provider Demographics
NPI:1225213374
Name:SANTIAGO, MYRNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6022
Mailing Address - Street 2:PMB 100
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-6022
Mailing Address - Country:US
Mailing Address - Phone:787-594-7328
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL PLAZA 66
Practice Address - Street 2:SUITE 5C
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-594-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3033235Z00000X
PR1869103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist