Provider Demographics
NPI:1508566175
Name:SANTIAGO ACOSTA, PAOLA MARIA
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:MARIA
Last Name:SANTIAGO ACOSTA
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:C CALLE 14 APT C203
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6243
Mailing Address - Country:US
Mailing Address - Phone:787-397-1005
Mailing Address - Fax:
Practice Address - Street 1:BONNEVILLE HEIGHTS CALLE AIBONITO 60
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-395-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist