Provider Demographics
NPI:1457072308
Name:SANTANA, BIANCA GABRIELA (MS)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:GABRIELA
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:GABRIELA
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 CALLE JUAN C BORBON STE 67-158
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5374
Mailing Address - Country:US
Mailing Address - Phone:939-276-6538
Mailing Address - Fax:
Practice Address - Street 1:URB GREENVILLE
Practice Address - Street 2:21 A CALLE 2
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:939-276-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist