Provider Demographics
NPI:1467728790
Name:SANTIAGO, DIANA L (MED)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0653
Mailing Address - Country:US
Mailing Address - Phone:787-617-9610
Mailing Address - Fax:787-837-7610
Practice Address - Street 1:ESTANCIAS DE JUANA DIAZ CALLE CYPRES B22
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-617-9610
Practice Address - Fax:787-837-7610
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist