Provider Demographics
NPI:1659410991
Name:SANTIAGO, TERRY JOAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:JOAN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:4244 RIVERWALK PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8509
Practice Address - Country:US
Practice Address - Phone:951-736-7432
Practice Address - Fax:951-736-7751
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP14831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01080865OtherRR MEDICARE - SO CALIF
CAP01080865OtherRR MEDICARE - SO CALIF
CAFU210ZMedicare PIN