Provider Demographics
NPI:1902361892
Name:SANTIAGO, AYINAIDA (PSYD)
Entity Type:Individual
Prefix:
First Name:AYINAIDA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CC34 CALLE JUMACAO
Mailing Address - Street 2:URB PARQUE DEL MONTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:939-940-7736
Mailing Address - Fax:
Practice Address - Street 1:AVE BORINQUEN BO OBRERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical