1811704182 NPI number — JONATHAN XAVIER MATEO SANTIAGO PSYD

Table of content: (NPI 1154988897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811704182 NPI number — JONATHAN XAVIER MATEO SANTIAGO PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATEO SANTIAGO
Provider First Name:
JONATHAN
Provider Middle Name:
XAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

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:
1811704182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HACIENDA LA MONSERRATE #514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-549-1232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2016 AV. BORINQUEN, CANO MARTIN PENA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-268-4171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2024

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:  8192 , 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)