Provider Demographics
NPI:1972301729
Name:SANTOLAYA, ANGELICA MARIE
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIE
Last Name:SANTOLAYA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6047 RED WOLF PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4403
Mailing Address - Country:US
Mailing Address - Phone:925-642-0165
Mailing Address - Fax:
Practice Address - Street 1:13950 BRANDYWINE RD
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5815
Practice Address - Country:US
Practice Address - Phone:301-782-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program