Provider Demographics
NPI:1720433808
Name:SANTIAGO, AMALIYA AVETYAN (ND)
Entity type:Individual
Prefix:DR
First Name:AMALIYA
Middle Name:AVETYAN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:AMALIYA
Other - Middle Name:AVETYAN
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:626-714-7400
Mailing Address - Fax:833-269-3526
Practice Address - Street 1:301 S FAIR OAKS AVE STE 208
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:626-714-7400
Practice Address - Fax:833-269-3526
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND799175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath