Provider Demographics
NPI:1750033882
Name:SANTIAGO, CRYSTAL (DOULA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 E 137TH ST APT 6H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3105
Mailing Address - Country:US
Mailing Address - Phone:516-309-7450
Mailing Address - Fax:
Practice Address - Street 1:584 E 137TH ST APT 6H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3105
Practice Address - Country:US
Practice Address - Phone:516-309-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty