Provider Demographics
NPI:1558835884
Name:SANTIAGO, ANGEL ANTHONY JR
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANTHONY
Last Name:SANTIAGO
Suffix:JR
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 1:518 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-4428
Mailing Address - Country:US
Mailing Address - Phone:432-254-1684
Mailing Address - Fax:
Practice Address - Street 1:518 W 6TH ST
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4428
Practice Address - Country:US
Practice Address - Phone:432-254-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant