Provider Demographics
NPI:1316265135
Name:JIMENEZ-SANTIAGO, KRISTEL L (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTEL
Middle Name:L
Last Name:JIMENEZ-SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA CARIBBEAN HEALTHCARE SYSTEM
Mailing Address - Street 2:10 CASIA ST.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3201
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:787-641-4557
Practice Address - Street 1:175 AVE ALGARROBO
Practice Address - Street 2:VA CARIBBEAN HEALTHCARE SYSTEM - MOPC
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6331
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-265-8826
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4283103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist