Provider Demographics
NPI:1245605427
Name:SANTIAGO, AMARILYS (LIC 3078)
Entity Type:Individual
Prefix:
First Name:AMARILYS
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LIC 3078
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 99
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0099
Mailing Address - Country:US
Mailing Address - Phone:787-800-0227
Mailing Address - Fax:
Practice Address - Street 1:4 CARR 31 # KM
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3868
Practice Address - Country:US
Practice Address - Phone:787-679-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30782355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant