Provider Demographics
NPI:1194948349
Name:SANTIAGO, ELIZABETH LADRIDO
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LADRIDO
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 1:8381 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4742
Mailing Address - Country:US
Mailing Address - Phone:907-677-7466
Mailing Address - Fax:907-334-9551
Practice Address - Street 1:8381 PIONEER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4742
Practice Address - Country:US
Practice Address - Phone:907-677-7466
Practice Address - Fax:907-334-9551
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000231310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL0807OtherMCI