Provider Demographics
NPI:1538326863
Name:SANTIAGO, KELLY LYN
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LYN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 CENTERPOINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1331
Mailing Address - Country:US
Mailing Address - Phone:805-739-8500
Mailing Address - Fax:805-739-8608
Practice Address - Street 1:2121 CENTERPOINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1331
Practice Address - Country:US
Practice Address - Phone:805-739-8500
Practice Address - Fax:805-739-8608
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator