Provider Demographics
NPI:1760836043
Name:SANTIAGO, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
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 1:1240 SHERMAN AVENUE APT A7
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:919-413-7238
Mailing Address - Fax:
Practice Address - Street 1:1240 SHERMAN AVE APT A7
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3024
Practice Address - Country:US
Practice Address - Phone:919-413-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator