Provider Demographics
NPI:1023584539
Name:SANTIAGO, CESARIA M
Entity type:Individual
Prefix:
First Name:CESARIA
Middle Name:M
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 1:699 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-2741
Mailing Address - Country:US
Mailing Address - Phone:951-487-3815
Mailing Address - Fax:951-350-0148
Practice Address - Street 1:699 WINNERS CIR
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-2741
Practice Address - Country:US
Practice Address - Phone:951-487-3815
Practice Address - Fax:951-350-0148
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95117612163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation