Provider Demographics
NPI:1548496474
Name:SANTIAGO, WILHELMINA MATIENZO (MD)
Entity type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:MATIENZO
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:360-566-4402
Mailing Address - Fax:915-577-9315
Practice Address - Street 1:7410 DELAWARE LN UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1408
Practice Address - Country:US
Practice Address - Phone:360-566-4402
Practice Address - Fax:360-566-4406
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5235208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036062Medicaid