Provider Demographics
NPI:1255410528
Name:SANTIAGO GONZALES, NYDIA I (AVD)
Entity type:Individual
Prefix:
First Name:NYDIA
Middle Name:I
Last Name:SANTIAGO GONZALES
Suffix:
Gender:F
Credentials:AVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIF CADILLA 100 PASEO SAN PABLO
Mailing Address - Street 2:SUITE 412
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7028
Mailing Address - Country:US
Mailing Address - Phone:787-798-5000
Mailing Address - Fax:787-798-5028
Practice Address - Street 1:EDIFICIO ARTURO CADILLA
Practice Address - Street 2:SUITE 412 HIMA SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7028
Practice Address - Country:US
Practice Address - Phone:787-798-5000
Practice Address - Fax:787-798-5028
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S31090Medicare UPIN
PR0064021Medicare ID - Type Unspecified