Provider Demographics
NPI:1275296089
Name:SANTIAGO, VANESSA
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name: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 1:1484 AVE F.D. ROOSEVELT
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2732
Mailing Address - Country:US
Mailing Address - Phone:787-783-4510
Mailing Address - Fax:787-792-0831
Practice Address - Street 1:1484 AVE F.D. ROOSEVELT
Practice Address - Street 2:SUITE 19
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2732
Practice Address - Country:US
Practice Address - Phone:787-783-4510
Practice Address - Fax:787-792-0831
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1184722019OtherNPI