Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | MD60395006 | WA |
Y | 207RS0012X | Sleep Medicine | MD60395006 | WA |
NPI | 1184926602 |
---|---|
Provider Name | Bryan Santiago |
First Address | Sunnyside, WA 98944-0510 |
Second Address | Grandview, WA 98930-9470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2010 |
Last Update Date | 17/12/2021 |