Provider Demographics
NPI:1285851089
Name:SANTIAGO, CARLOS (MA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION SAN JOSE
Mailing Address - Street 2:E-15-A
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-738-5020
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE DE DIEGO 392 OESTE
Practice Address - Street 2:APARTADO 372770
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-2770
Practice Address - Country:US
Practice Address - Phone:787-738-2222
Practice Address - Fax:787-738-2149
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical