Provider Demographics
NPI:1225285174
Name:MANOSA SANTIAGO, IRIS B
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:B
Last Name:MANOSA 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 1:600 BLVD DE LA MONTANA
Mailing Address - Street 2:APARTADO 464
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7106
Mailing Address - Country:US
Mailing Address - Phone:787-449-0431
Mailing Address - Fax:
Practice Address - Street 1:60 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 214
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-503-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR664OtherSTATE LICENCE IN SPEECH/LANGUAGE PATHOLOGY