Provider Demographics
NPI:1871333724
Name:SANTIAGO, JOSE CRISTOBAL SR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CRISTOBAL
Last Name:SANTIAGO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CALLE 36
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3159
Mailing Address - Country:US
Mailing Address - Phone:784-444-9480
Mailing Address - Fax:
Practice Address - Street 1:400 CALLE 36
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3159
Practice Address - Country:US
Practice Address - Phone:784-444-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8473104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker