Provider Demographics
NPI:1255587861
Name:SANTIAGO PAGAN, WALESKA (PSYD)
Entity type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:
Last Name:SANTIAGO PAGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M6 CALLE 14
Mailing Address - Street 2:URB ESTANCIAS LAS TRINITARIAS
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00704
Mailing Address - Country:US
Mailing Address - Phone:787-354-3735
Mailing Address - Fax:787-354-3735
Practice Address - Street 1:M 239 CARR. 2
Practice Address - Street 2:VILLA CAPARRA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1915
Practice Address - Country:US
Practice Address - Phone:787-354-3735
Practice Address - Fax:787-354-3735
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3165103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist