| Doctor Name: | DR. EDUARDO SANTIAGO |
| NPI Number: | 1013312255 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | |
| Business Practice Address: | 400 S Broadway # 6 Edmond, OK - 730343848 |
| Business Phone Number: | 5805120193 |
| Business Fax Number: | |
| Mailing Address: | 104 Maple St, ELGIN |
| State: | OK |
| Postal Code: | 735388835 |
| Phone Number: | 5805120193 |
| Fax Number: | |
| NPI Enumeration Date: | 10/30/2014 |
| NPI Last Update Date: | 10/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |