Provider Demographics
NPI:1275993230
Name:SANTIAGO, IVETTE ELVIRA
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:ELVIRA
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:URB. EL CONQUISTADOR
Mailing Address - Street 2:R-28 13TH ST
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:UM
Mailing Address - Phone:787-387-9845
Mailing Address - Fax:
Practice Address - Street 1:URB. EL CONQUISTADOR
Practice Address - Street 2:R-28 13TH ST
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:UM
Practice Address - Phone:787-387-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist