Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 020638 | PR |
Y | 207RI0200X | Infectious Disease | 151454 | CA |
NPI | 1053623520 |
---|---|
Provider Name | Alexandra Santiago-Vazquez |
First Address | Sacramento, CA 95811-5216 |
Second Address | Sacramento, CA 95811-5216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 26/12/2017 |