Provider Demographics
NPI:1427739671
Name:SANTIAGO, TIARE KAIULANI
Entity type:Individual
Prefix:
First Name:TIARE
Middle Name:KAIULANI
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 1:95-315 KAILIULA LOOP
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1333
Mailing Address - Country:US
Mailing Address - Phone:808-285-5737
Mailing Address - Fax:
Practice Address - Street 1:95-315 KAILIULA LOOP
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1333
Practice Address - Country:US
Practice Address - Phone:808-285-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health