Provider Demographics
NPI:1578596490
Name:SANTIAGO, ELVIA L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELVIA
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CALLE PEPE DIAZ
Mailing Address - Street 2:
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-1106
Mailing Address - Country:US
Mailing Address - Phone:787-224-8381
Mailing Address - Fax:787-727-7698
Practice Address - Street 1:1812 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911-1826
Practice Address - Country:US
Practice Address - Phone:787-728-0058
Practice Address - Fax:787-727-7698
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29832164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse