Provider Demographics
NPI:1841596780
Name:SANTIAGO, VICMAR
Entity Type:Individual
Prefix:
First Name:VICMAR
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 1:1257 SW 46TH AVE
Mailing Address - Street 2:#1809
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-6440
Mailing Address - Country:US
Mailing Address - Phone:954-756-5920
Mailing Address - Fax:
Practice Address - Street 1:1257 SW 46TH AVE
Practice Address - Street 2:#1809
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-6440
Practice Address - Country:US
Practice Address - Phone:954-756-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst