Provider Demographics
NPI:1740738376
Name:SANTIAGO, NORMARIE
Entity Type:Individual
Prefix:
First Name:NORMARIE
Middle Name:
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 1:3004-B BALCONES DE MONTE REAL
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-617-6919
Mailing Address - Fax:
Practice Address - Street 1:40 COND BALCONES DE MONTE REAL
Practice Address - Street 2:APT. 3004
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2266
Practice Address - Country:US
Practice Address - Phone:787-617-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR922235Z00000X
CA23506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist