Provider Demographics
NPI:1871805853
Name:NIEVES SANTIAGO, SONIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:NIEVES SANTIAGO
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43001 STE 247
Mailing Address - Street 2:VILLAS DE RIO GRANDE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:UM
Mailing Address - Phone:787-364-9036
Mailing Address - Fax:787-887-7837
Practice Address - Street 1:K2 CALLE 4 VILLAS DE RIO GRANDE
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-2823
Practice Address - Country:US
Practice Address - Phone:787-887-7837
Practice Address - Fax:787-887-7837
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3791103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3791OtherLICENCE OF PSYCHOLOGIST