Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1669635041 |
---|---|
Provider Name | Mr. Wilbur Jose Santiago |
First Address | San Juan, PR 00936-2183 |
Second Address | Guaynabo, PR 00965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 07/07/2008 |