Provider Demographics
NPI:1174173496
Name:SANTANA-MORIN, TATIANA ISIS
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:ISIS
Last Name:SANTANA-MORIN
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 1:8 HUBBARD PL
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2333
Mailing Address - Country:US
Mailing Address - Phone:860-462-7266
Mailing Address - Fax:
Practice Address - Street 1:45 WADSWORTH ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-7108
Practice Address - Country:US
Practice Address - Phone:860-527-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program