Provider Demographics
NPI:1003783853
Name:SANTIAGO, CARMEN DELIA (LAC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:DELIA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 6TH RD
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08346-2022
Mailing Address - Country:US
Mailing Address - Phone:609-805-6939
Mailing Address - Fax:
Practice Address - Street 1:630 B S. BLACKHORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08237
Practice Address - Country:US
Practice Address - Phone:609-805-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00179300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist