Provider Demographics
NPI:1942886916
Name:SANTOS, JALEYKA NICOLE
Entity Type:Individual
Prefix:
First Name:JALEYKA
Middle Name:NICOLE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.GOLDEN HILLS
Mailing Address - Street 2:CALLE VENUS 1738
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-615-7342
Mailing Address - Fax:
Practice Address - Street 1:URB.GOLDEN HILLS 1738
Practice Address - Street 2:CALLE VENUS
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-615-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013869183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1827555OtherNO TENGO MEDICARE