Provider Demographics
NPI:1861034589
Name:SANTIAGO, KRISSTAL (MSC, ACC, LMT, CST)
Entity Type:Individual
Prefix:
First Name:KRISSTAL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MSC, ACC, LMT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 SW LEVETON DR # N3136
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-6070
Mailing Address - Country:US
Mailing Address - Phone:318-306-5661
Mailing Address - Fax:
Practice Address - Street 1:12540 SW LEVETON DR # N3136
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-6070
Practice Address - Country:US
Practice Address - Phone:318-306-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach