Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3398 | PR |
N | 103TA0700X | Adult Development & Aging Psychologist | 3398 | PR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3398 | PR |
Y | 103G00000X | Clinical Psychologist | 3398 | PR |
Y | 103TC0700X | Clinical Psychologist | 3398 | PR |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3398 | PR |
N | 103TF0200X | Forensic Psychologist | 3398 | PR |
N | 103TH0100X | Health Service | 3398 | PR |
NPI | 1629205463 |
---|---|
Provider Name | Dr. Santiago Rivera-Santos |
First Address | San Juan, PR 00901-1959 |
Second Address | San Juan, PR 00901-1959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2009 |
Last Update Date | 19/06/2009 |