Provider Demographics
NPI:1356698906
Name:SANTIAGO, MAIRA L (RDMS)
Entity type:Individual
Prefix:MRS
First Name:MAIRA
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SEVEN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7942
Mailing Address - Country:US
Mailing Address - Phone:570-369-8888
Mailing Address - Fax:
Practice Address - Street 1:808 SEVEN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7942
Practice Address - Country:US
Practice Address - Phone:570-369-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ718432471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography