Provider Demographics
NPI:1710189485
Name:SANTIAGO, MARITZA (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 247
Mailing Address - Street 2:BO MARUENO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9704
Mailing Address - Country:US
Mailing Address - Phone:787-290-0418
Mailing Address - Fax:787-836-6102
Practice Address - Street 1:963 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1401
Practice Address - Country:US
Practice Address - Phone:787-836-2173
Practice Address - Fax:787-836-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2998183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2998OtherCPHT