Basic Information
| Provider Information | |||||||||
| NPI: | 1740294776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTIAGO | ||||||||
| FirstName: | RINA | ||||||||
| MiddleName: | SHAILY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 NW 11TH ST | ||||||||
| Address2: | STE W201 | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330304361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024836990 | ||||||||
| FaxNumber: | 4024837045 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 NW 11TH STREET | ||||||||
| Address2: | SUITE W-201 | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865215925 | ||||||||
| FaxNumber: | 3057169114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 470798717-29 | 05 | NE | MEDICAID | 470798717-26 | 05 | NE | MEDICAID | 470798717-27 | 05 | NE | MEDICAID |