Provider Demographics
NPI:1245471507
Name:ORELLANA, SANTIAGO ALFONSO
Entity type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:ALFONSO
Last Name:ORELLANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 N MARMORA AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1729
Mailing Address - Country:US
Mailing Address - Phone:773-653-5274
Mailing Address - Fax:
Practice Address - Street 1:4130 N MARMORA AVE
Practice Address - Street 2:FL 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1729
Practice Address - Country:US
Practice Address - Phone:773-653-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter