Provider Demographics
NPI:1770133183
Name:SANTIAGO, MARTHA J
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:J
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 1:4224 CAMINO DE LA PLZ APT 25D
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3033
Mailing Address - Country:US
Mailing Address - Phone:619-864-6029
Mailing Address - Fax:
Practice Address - Street 1:1575 KIMBERLY WOODS DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7261
Practice Address - Country:US
Practice Address - Phone:619-328-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider