Provider Demographics
NPI:1942051131
Name:SANTIAGO, ROSAURA (CMT 000393)
Entity Type:Individual
Prefix:
First Name:ROSAURA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CMT 000393
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALLE CARRO
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4844
Mailing Address - Country:US
Mailing Address - Phone:787-362-1297
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE CARRO
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4844
Practice Address - Country:US
Practice Address - Phone:787-362-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist