Provider Demographics
NPI:1497355309
Name:SANTIAGO, CARMEN IBELY (NL)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:IBELY
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GRAND BLVD LOS PRADOS APT 19102
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3262
Mailing Address - Country:US
Mailing Address - Phone:787-642-5431
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE GOYCO STE 4
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2800
Practice Address - Country:US
Practice Address - Phone:787-642-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR145175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath