Provider Demographics
NPI:1922014877
Name:SANTIAGO, ELEANOR (MD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11755 VICTORY BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3423
Mailing Address - Country:US
Mailing Address - Phone:818-762-9883
Mailing Address - Fax:818-762-3237
Practice Address - Street 1:11755 VICTORY BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3423
Practice Address - Country:US
Practice Address - Phone:818-762-9883
Practice Address - Fax:818-762-3237
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30385207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26093Medicare UPIN
CAA30385AMedicare ID - Type Unspecified