Provider Demographics
NPI:1245422377
Name:SANTIAGO, NELISSA JOAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NELISSA
Middle Name:JOAN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LA CAMPINA A 4 CALLE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9635
Mailing Address - Country:US
Mailing Address - Phone:787-649-8352
Mailing Address - Fax:
Practice Address - Street 1:URB. LA CAMPINA A 4 CALLE 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9635
Practice Address - Country:US
Practice Address - Phone:787-649-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist