Individual
BIANCA IVETTE SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 E LEHIGH AVE, CHC-2-EAST, PHILADELPHIA, PA 19125-1012
(215) 707-1118
(215) 707-1120
Mailing address
100 E LEHIGH AVE, CHC-2 EAST, PHILADELPHIA, PA 19182-0933
(215) 707-1118
(215) 707-1120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA051267
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121986
MEDICARE
—
01
—
597586
MEDICARE GROUP
PA
Enumeration date
12/01/2005
Last updated
10/21/2014
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