Provider Demographics
NPI:1154994689
Name:SANTIAGO, PEARLITA RANADA (FNP)
Entity type:Individual
Prefix:
First Name:PEARLITA
Middle Name:RANADA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PEARL
Other - Middle Name:R
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3278 SAN PABLO WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2728
Mailing Address - Country:US
Mailing Address - Phone:510-648-6429
Mailing Address - Fax:
Practice Address - Street 1:198 N G STREET
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:CA
Practice Address - Zip Code:95319-0000
Practice Address - Country:US
Practice Address - Phone:866-682-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF07211159363L00000X
CA95018443363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner