Provider Demographics
NPI:1295593549
Name:ROJAS SANTIAGO, ANGEL MANUEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MANUEL
Last Name:ROJAS SANTIAGO
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 1:2809 N LOS FELICES CIR E UNIT G202
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-8400
Mailing Address - Country:US
Mailing Address - Phone:760-218-7176
Mailing Address - Fax:
Practice Address - Street 1:2809 N LOS FELICES CIR E UNIT G202
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-8400
Practice Address - Country:US
Practice Address - Phone:760-218-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist