Provider Demographics
NPI:1467717488
Name:SANTIAGO, NICOLE YALIZ (ATF)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:YALIZ
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:ATF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CALLE SAN JOVINO
Mailing Address - Street 2:URB. SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4212
Mailing Address - Country:US
Mailing Address - Phone:787-747-1374
Mailing Address - Fax:
Practice Address - Street 1:421 CALLE SAN JOVINO
Practice Address - Street 2:URB. SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4212
Practice Address - Country:US
Practice Address - Phone:787-747-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2073225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant