Provider Demographics
NPI:1962175612
Name:SANTIAGO, KARLA THERESE VIRAY
Entity type:Individual
Prefix:MS
First Name:KARLA THERESE
Middle Name:VIRAY
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 1:5515 CANOGA AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6630
Mailing Address - Country:US
Mailing Address - Phone:909-507-8671
Mailing Address - Fax:
Practice Address - Street 1:5515 CANOGA AVE APT 310
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6630
Practice Address - Country:US
Practice Address - Phone:909-507-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician