Provider Demographics
NPI:1659423820
Name:SANTIAGO, GERNANIE CRUZ (MS)
Entity Type:Individual
Prefix:
First Name:GERNANIE
Middle Name:CRUZ
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:NAN
Other - Middle Name:CRUZ
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:801 TRAEGER AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3048
Mailing Address - Country:US
Mailing Address - Phone:650-742-2130
Mailing Address - Fax:
Practice Address - Street 1:801 TRAEGER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3048
Practice Address - Country:US
Practice Address - Phone:650-742-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional