Provider Demographics
NPI:1528279973
Name:SANTIAGO, DIANY DE L (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANY
Middle Name:DE L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RES VILLA ANDALUCIA
Mailing Address - Street 2:STREET COIN I-28
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2322
Mailing Address - Country:US
Mailing Address - Phone:787-533-3546
Mailing Address - Fax:
Practice Address - Street 1:STREET AQUAMARINA # 66
Practice Address - Street 2:RES VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical