Provider Demographics
NPI:1760901250
Name:MATEO SANTIAGO, XAIRA IVETTE (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:XAIRA
Middle Name:IVETTE
Last Name:MATEO SANTIAGO
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9016
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9016
Mailing Address - Country:US
Mailing Address - Phone:787-843-7808
Mailing Address - Fax:787-813-0798
Practice Address - Street 1:1935 AVE LAS AMERICAS
Practice Address - Street 2:URB SAN ANTONIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-843-7808
Practice Address - Fax:787-813-0798
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4027OtherMEDICAL LICENSE