Provider Demographics
NPI:1881207025
Name:SANTIAGO, GENEVIEVE MARIA (MA)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:MARIA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GENEIEVE
Other - Middle Name:MARIA
Other - Last Name:RIBOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3101 WOODHAVEN RD APT M3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1740
Mailing Address - Country:US
Mailing Address - Phone:631-575-5820
Mailing Address - Fax:
Practice Address - Street 1:3101 WOODHAVEN RD APT M3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1740
Practice Address - Country:US
Practice Address - Phone:631-575-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator