Provider Demographics
NPI:1356692255
Name:SANTIAGO, DIANA
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CASSE CT
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4505
Mailing Address - Country:US
Mailing Address - Phone:845-621-0146
Mailing Address - Fax:845-621-0146
Practice Address - Street 1:24 CASSE CT
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4505
Practice Address - Country:US
Practice Address - Phone:845-621-0146
Practice Address - Fax:845-621-0146
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator