Provider Demographics
NPI:1437293289
Name:SANTIAGO, JANITZA
Entity Type:Individual
Prefix:
First Name:JANITZA
Middle Name:
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 1:462 CALLE RINCON
Mailing Address - Street 2:VILLA DOS PINOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:586 CALLE NAPOLES
Practice Address - Street 2:VILLA CAPRI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4604
Practice Address - Country:US
Practice Address - Phone:787-755-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4832183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician