1073731980 NPI number — JOANIE MORALES-SANTIAGO PSY. D.

Table of content: JOANIE MORALES-SANTIAGO PSY. D. (NPI 1073731980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073731980 NPI number — JOANIE MORALES-SANTIAGO PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES-SANTIAGO
Provider First Name:
JOANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073731980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB VALLE ALTO
Provider Second Line Business Mailing Address:
2304 CALLE LOMA
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00730-4145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-702-3918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8133 CALLE CONCORDIA
Provider Second Line Business Practice Location Address:
OFICINA 202
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-466-4287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1766 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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