Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2138 | PR |
Y | 103TC0700X | Clinical Psychologist | 2138 | PR |
NPI | 1003969544 |
---|---|
Provider Name | Antonio Rivera Santiago |
First Address | Humacao, PR 00791-6305 |
Second Address | Caguas, PR 00725-2683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 04/06/2021 |