Provider Demographics
NPI:1902616014
Name:DESANTIAGO, AMANDA MARIE (CHW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:DESANTIAGO
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:ALMAGUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6801 S IH 35 STE 1-E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4824
Mailing Address - Country:US
Mailing Address - Phone:512-978-8750
Mailing Address - Fax:
Practice Address - Street 1:6801 S IH 35 STE 1-E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4824
Practice Address - Country:US
Practice Address - Phone:512-978-8750
Practice Address - Fax:512-776-0470
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12394172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker