Provider Demographics
NPI:1588223457
Name:SANTIAGO-SANTIAGO, IRMA JESSICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:JESSICA
Last Name:SANTIAGO-SANTIAGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 AVE DONA FELISA RINCON
Mailing Address - Street 2:PASEOMONTE 901
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6659
Mailing Address - Country:US
Mailing Address - Phone:787-553-2000
Mailing Address - Fax:
Practice Address - Street 1:381 AVE DONA FELISA RINCON
Practice Address - Street 2:PASEOMONTE 901
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6659
Practice Address - Country:US
Practice Address - Phone:787-553-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty