Basic Information
| Provider Information | |||||||||
| NPI: | 1437621281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTIAGO | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | AMARILYS | ||||||||
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| Mailing Information | |||||||||
| Address1: | URBANIZACION CAFETAL 2 | ||||||||
| Address2: | L6 CALLE CATURRA | ||||||||
| City: | YAUCO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873856851 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARR 153 KM | ||||||||
| Address2: | COAMO PLAZA SHOPPING CENTER | ||||||||
| City: | COAMO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2018 | ||||||||
| LastUpdateDate: | 12/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 14352 | PR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.