Provider Demographics
NPI:1811769508
Name:SANTIAGO, JULIAN A
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:A
Last Name: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:P.OBOX 486
Mailing Address - Street 2:
Mailing Address - City:JONESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17038
Mailing Address - Country:US
Mailing Address - Phone:267-683-0050
Mailing Address - Fax:
Practice Address - Street 1:111 TWIN CREEKS DR
Practice Address - Street 2:
Practice Address - City:JONESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17038-8348
Practice Address - Country:US
Practice Address - Phone:267-683-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide