Provider Demographics
NPI:1265014138
Name:SANTIAGO, YASHIRA SANTIAGO (MSW)
Entity Type:Individual
Prefix:
First Name:YASHIRA
Middle Name:SANTIAGO
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS CAOBOS
Mailing Address - Street 2:CALLE ACEROLA 943
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-432-6627
Mailing Address - Fax:
Practice Address - Street 1:URB. LOS CAOBOS
Practice Address - Street 2:CALLE ACEROLA 943
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-432-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
15516OtherSOCIAL WORKER CLNIC
PR15516OtherTRABAJADORA SOCIAL CLNICA