Provider Demographics
NPI:1528538063
Name:SANTIAGO-GREATHOUSE, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:SANTIAGO-GREATHOUSE
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 1:790 E BOULDER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-1237
Mailing Address - Country:US
Mailing Address - Phone:559-790-4275
Mailing Address - Fax:
Practice Address - Street 1:790 E BOULDER CREEK LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-1237
Practice Address - Country:US
Practice Address - Phone:559-790-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD2990017347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle