Provider Demographics
NPI:1346448677
Name:SANTIAGO, GELIZA IVETTE (MT)
Entity Type:Individual
Prefix:
First Name:GELIZA
Middle Name:IVETTE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G2 CALLE JADE
Mailing Address - Street 2:URB. LA MILAGROSA
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2010
Mailing Address - Country:US
Mailing Address - Phone:787-873-5081
Mailing Address - Fax:
Practice Address - Street 1:G2 CALLE JADE
Practice Address - Street 2:URB. LA MILAGROSA
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-2010
Practice Address - Country:US
Practice Address - Phone:787-873-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6732246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical