Provider Demographics
NPI:1295534022
Name:CARHUATANTA, SANTIAGO MOISES
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:MOISES
Last Name:CARHUATANTA
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 1:750 E 200 S APT 12
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2215
Mailing Address - Country:US
Mailing Address - Phone:801-680-9738
Mailing Address - Fax:
Practice Address - Street 1:4765 W 5015 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-6230
Practice Address - Country:US
Practice Address - Phone:385-354-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician