Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1043588064 |
---|---|
Provider Name | Emerita Santiago |
First Address | Las Vegas, NV 89119-6137 |
Second Address | Las Vegas, NV 89119-6137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2011 |
Last Update Date | 05/12/2011 |