Provider Demographics
NPI:1780963298
Name:SANTIAGO, KATIA K (MA)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:K
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 AVE SAN IGNACIO
Mailing Address - Street 2:URB. ALTAMESA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4739
Mailing Address - Country:US
Mailing Address - Phone:787-707-1090
Mailing Address - Fax:
Practice Address - Street 1:1474 AVE SAN IGNACIO
Practice Address - Street 2:URB. ALTAMESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4739
Practice Address - Country:US
Practice Address - Phone:787-707-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist