Provider Demographics
NPI:1265232748
Name:DE SANTIAGO, DORA
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:DE SANTIAGO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ZACHRY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-4157
Mailing Address - Country:US
Mailing Address - Phone:210-724-3275
Mailing Address - Fax:
Practice Address - Street 1:211 ZACHRY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-4157
Practice Address - Country:US
Practice Address - Phone:210-724-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home