Provider Demographics
NPI:1194303081
Name:SANTIAGO MORALES, SILVIA MARIA (MD)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:MARIA
Last Name:SANTIAGO MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SILVIA
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SILVIA SANTIAGO, MD
Mailing Address - Street 1:1035 ALTO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2406
Mailing Address - Country:US
Mailing Address - Phone:505-955-0322
Mailing Address - Fax:
Practice Address - Street 1:1035 ALTO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2406
Practice Address - Country:US
Practice Address - Phone:505-955-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMMD2024-0869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program