Provider Demographics
NPI:1972983492
Name:OSTOLAZA SANTIAGO, MARIENE ENID (MSPT)
Entity type:Individual
Prefix:
First Name:MARIENE
Middle Name:ENID
Last Name:OSTOLAZA SANTIAGO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. MILLENIA PARK 1 CALLE FERRER APT 411
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4205
Mailing Address - Country:US
Mailing Address - Phone:787-662-4030
Mailing Address - Fax:
Practice Address - Street 1:500 CALLE BAEZ
Practice Address - Street 2:URB. PEREZ MORIS
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919-5661
Practice Address - Country:US
Practice Address - Phone:787-767-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist