# IRMA MARIANA SANTIAGO LAGO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1184866675
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2018-00102 | NC | Yes |
| 207Q00000X | Family Medicine Physician | MD2012-0350 | NM | — |

## Other

- **Enumeration date:** 03/30/2009
- **Last updated:** 10/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 85784842 | — | NM |
| 01 | — | NMA102941 | MEDICARE PTAN | — |