Provider Demographics
NPI:1700024171
Name:SANTIAGO, IVLYPS MARIE
Entity Type:Individual
Prefix:
First Name:IVLYPS
Middle Name:MARIE
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 1:35 ST URB. RIVER VIEW
Mailing Address - Street 2:#ZD-33
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:939-717-2092
Mailing Address - Fax:
Practice Address - Street 1:ZD33 CALLE 35
Practice Address - Street 2:RIVER VIEW
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3925
Practice Address - Country:US
Practice Address - Phone:939-717-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7663183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician