Provider Demographics
NPI:1619560620
Name:SANTIAGO, ALEXANDRIA DENISE
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:DENISE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9732
Mailing Address - Country:US
Mailing Address - Phone:916-960-9881
Mailing Address - Fax:
Practice Address - Street 1:MAXIM HEALTHCARE SERVICES
Practice Address - Street 2:293 INDEPENDENCE BLVD SUITE 4
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-490-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1516177175OtherTRICARE