Provider Demographics
NPI:1659070878
Name:MARENGO SANTIAGO, IRIS MYRIAM
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:MYRIAM
Last Name:MARENGO 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:RR 14 BOX 5334
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-730-3446
Mailing Address - Fax:
Practice Address - Street 1:COLINAS DEL SOL II 45 CALLE 4 APT 4511
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-7013
Practice Address - Country:US
Practice Address - Phone:787-730-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant