Provider Demographics
NPI:1932865516
Name:RIVERA-SANTIAGO, JOSE ALBERTO (MT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALBERTO
Last Name:RIVERA-SANTIAGO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1255 HILLRISE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4741
Mailing Address - Country:US
Mailing Address - Phone:575-532-5934
Mailing Address - Fax:575-522-9047
Practice Address - Street 1:1255 HILLRISE CIR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4741
Practice Address - Country:US
Practice Address - Phone:575-532-5934
Practice Address - Fax:575-522-9047
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM196865246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist