Provider Demographics
NPI:1093990962
Name:SANTIAGO, ESTELA L
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BERGER LANE
Mailing Address - Street 2:TOPPENISH WA
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948
Mailing Address - Country:US
Mailing Address - Phone:509-985-4801
Mailing Address - Fax:
Practice Address - Street 1:515 ZILLAH AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1485
Practice Address - Country:US
Practice Address - Phone:509-985-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00057238164W00000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171R00000XOther Service ProvidersInterpreter