Provider Demographics
NPI:1124454020
Name:SANTIAGO, OLGA LISSETTE (DR)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:LISSETTE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ESCORPION 202
Mailing Address - Street 2:URB. BRISAS DE LOIZA
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-632-5038
Mailing Address - Fax:
Practice Address - Street 1:CALLE AMATISTA E38
Practice Address - Street 2:APARTADO 170 URBANIZACION MANSIONES DEL CARIBE
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-632-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist