Individual
MARGO ILIMA SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6001
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2019-0065
NM
363AS0400X
Surgical Physician Assistant
PA2019-0065
NM
Other
Enumeration date
09/17/2019
Last updated
11/18/2019
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