Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY9963 | FL |
Y | 103TC0700X | Clinical Psychologist | PY9963 | FL |
N | 103G00000X | Clinical Psychologist | 9963 | FL |
N | 103TC0700X | Clinical Psychologist | 9963 | FL |
N | 103TH0004X | Health Psychologist | 9963 | FL |
N | 103TR0400X | Rehabilitation Psychologist | PY9963 | FL |
NPI | 1629589833 |
---|---|
Provider Name | Dr. Cristina Carolina Santiago |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2017 |
Last Update Date | 17/03/2021 |