Provider Demographics
NPI:1285997809
Name:CAROLINA RUIZ SANTIAGO
Entity type:Organization
Organization Name:CAROLINA RUIZ SANTIAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:215-279-3432
Mailing Address - Street 1:3346 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134
Mailing Address - Country:US
Mailing Address - Phone:215-279-3432
Mailing Address - Fax:
Practice Address - Street 1:3346 EMERALD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2548
Practice Address - Country:US
Practice Address - Phone:215-279-3432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty