Provider Demographics
NPI:1366827701
Name:SANTIAGO, HUMBERTO JAVIER (BA)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:JAVIER
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 W PLANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3014
Mailing Address - Country:US
Mailing Address - Phone:407-960-7373
Mailing Address - Fax:
Practice Address - Street 1:462 W PLANT ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3014
Practice Address - Country:US
Practice Address - Phone:407-960-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator