Provider Demographics
NPI:1518375492
Name:GUILLEN-SANTIAGUIN, JENYFFER YERALDINE
Entity Type:Individual
Prefix:
First Name:JENYFFER
Middle Name:YERALDINE
Last Name:GUILLEN-SANTIAGUIN
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 1:4980 APOLLOSTAR CT APT 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-5536
Mailing Address - Country:US
Mailing Address - Phone:702-491-0653
Mailing Address - Fax:
Practice Address - Street 1:1448 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1705
Practice Address - Country:US
Practice Address - Phone:702-382-4061
Practice Address - Fax:702-382-4071
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst