Provider Demographics
NPI:1588709885
Name:SANTIAGO, MAYRA NOEMI
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:NOEMI
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 1:9 CALLE BOBBY CAPO
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2422
Mailing Address - Country:US
Mailing Address - Phone:787-825-2228
Mailing Address - Fax:787-825-2228
Practice Address - Street 1:9 CALLE BOBBY CAPO
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2422
Practice Address - Country:US
Practice Address - Phone:787-825-2228
Practice Address - Fax:787-825-2228
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2599183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician