Provider Demographics
NPI:1750656385
Name:SANTIAGO, CATRINA DENISE
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:DENISE
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 1:3801 CANAL ST STE 314
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6082
Mailing Address - Country:US
Mailing Address - Phone:504-483-7243
Mailing Address - Fax:504-483-7264
Practice Address - Street 1:3801 CANAL ST STE 314
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6082
Practice Address - Country:US
Practice Address - Phone:504-483-7243
Practice Address - Fax:504-483-7264
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721447520Medicaid