Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1164716494 |
---|---|
Provider Name | Mrs. Mary Jane C Santiago |
First Address | San Carlos, CA 94070-6221 |
Second Address | San Carlos, CA 94070-6221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 03/06/2011 |