Provider Demographics
NPI:1518285881
Name:MANITI, SANTIAGO M
Entity Type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:M
Last Name:MANITI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3358
Mailing Address - Country:US
Mailing Address - Phone:907-646-4084
Mailing Address - Fax:907-644-9975
Practice Address - Street 1:3413 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3358
Practice Address - Country:US
Practice Address - Phone:907-646-4084
Practice Address - Fax:907-644-9975
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK911629103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst