Provider Demographics
NPI:1437010840
Name:DE SANTIAGO, MAYRA BELEN
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:BELEN
Last Name:DE 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 1:7344 MAGNOLIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3819
Mailing Address - Country:US
Mailing Address - Phone:714-510-5172
Mailing Address - Fax:951-755-8856
Practice Address - Street 1:7344 MAGNOLIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3819
Practice Address - Country:US
Practice Address - Phone:714-510-5172
Practice Address - Fax:951-755-8856
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker