Provider Demographics
NPI:1992009021
Name:SANTIAGO, XIOMARA
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:
Last Name:SANTIAGO
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:STREET TRINITARIA #11 HATILLO # 387
Mailing Address - Street 2:PMB P O BOX 6004
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-6004
Mailing Address - Country:US
Mailing Address - Phone:787-847-8600
Mailing Address - Fax:787-847-3336
Practice Address - Street 1:STREET 149 KM 58.1 SECTOR TIERRA SANTA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-1542
Practice Address - Country:US
Practice Address - Phone:787-847-8600
Practice Address - Fax:787-847-3336
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6110183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician