Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1589 | PR |
NPI | 1013226083 |
---|---|
Provider Name | Edward Santiago |
First Address | Cabo Rojo, PR 00623 |
Second Address | Mayaguez, PR 00682-1560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2010 |
Last Update Date | 24/09/2010 |