Provider Demographics
NPI:1689058752
Name:CALES-SANTIAGO, DELVALIS
Entity Type:Individual
Prefix:
First Name:DELVALIS
Middle Name:
Last Name:CALES-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 1:3205 ESPINOSA DR
Mailing Address - Street 2:APT 200
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0950
Mailing Address - Country:US
Mailing Address - Phone:407-994-8002
Mailing Address - Fax:
Practice Address - Street 1:3205 ESPINOSA DR
Practice Address - Street 2:APT 200
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0950
Practice Address - Country:US
Practice Address - Phone:407-994-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
PR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker