Provider Demographics
NPI:1043032394
Name:DE SANTIAGO, ITCZEL M (MSN, RN, CA-CP SANE)
Entity type:Individual
Prefix:
First Name:ITCZEL
Middle Name:M
Last Name:DE SANTIAGO
Suffix:
Gender:F
Credentials:MSN, RN, CA-CP SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 GREEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2136
Mailing Address - Country:US
Mailing Address - Phone:915-256-5253
Mailing Address - Fax:
Practice Address - Street 1:1719 GREEN OAKS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2136
Practice Address - Country:US
Practice Address - Phone:915-256-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX911718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty