Provider Demographics
NPI:1346913670
Name:OSTOLAZA SANTIAGO, FRANCES ENID (PHD)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:ENID
Last Name:OSTOLAZA SANTIAGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 VILLA NAVARRA CALLE GARCIA LEDESMA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3766
Mailing Address - Country:US
Mailing Address - Phone:787-512-2058
Mailing Address - Fax:
Practice Address - Street 1:614 VILLA NAVARRA CALLE GARCIA LEDESMA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3766
Practice Address - Country:US
Practice Address - Phone:787-512-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7038103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service