Provider Demographics
NPI:1912734500
Name:SANTIAGO RODRIGUEZ, WILMARY
Entity type:Individual
Prefix:
First Name:WILMARY
Middle Name:
Last Name:SANTIAGO RODRIGUEZ
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 1:8330 E HARTFORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7205
Mailing Address - Country:US
Mailing Address - Phone:480-745-3547
Mailing Address - Fax:480-745-3548
Practice Address - Street 1:8330 E HARTFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7205
Practice Address - Country:US
Practice Address - Phone:480-745-3547
Practice Address - Fax:480-745-3548
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant