Provider Demographics
NPI:1962789982
Name:SANTIAGO, JOCELYN S
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:S
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 1:3668 GREENFIELD LAKES ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-4108
Mailing Address - Country:US
Mailing Address - Phone:702-457-6080
Mailing Address - Fax:
Practice Address - Street 1:4895 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3012
Practice Address - Country:US
Practice Address - Phone:702-898-5264
Practice Address - Fax:702-898-5274
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist