Provider Demographics
NPI:1619516432
Name:PADILLA SANTIAGO, MELODIE KATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:KATHERINE
Last Name:PADILLA 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:URB ALTURAS DE PENUELAS 2 CALLE ESMERALDA 716
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-2313
Mailing Address - Country:US
Mailing Address - Phone:720-469-4590
Mailing Address - Fax:
Practice Address - Street 1:CALLE RAMON EMETERIO BETANCES, #392
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ, PR
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-805-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical