Provider Demographics
NPI:1306538905
Name:ALCANTARA, MICHAEL RONALD SANTIAGO (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL RONALD
Middle Name:SANTIAGO
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CREIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5222
Mailing Address - Country:US
Mailing Address - Phone:501-554-3544
Mailing Address - Fax:
Practice Address - Street 1:250 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4218
Practice Address - Country:US
Practice Address - Phone:626-963-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95217647163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency