Provider Demographics
NPI:1033749411
Name:INFANZON SANTIAGO, ALEXANDRA CECILLE (DMSC, MPH, PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CECILLE
Last Name:INFANZON SANTIAGO
Suffix:
Gender:F
Credentials:DMSC, MPH, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 2ND AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5045
Mailing Address - Country:US
Mailing Address - Phone:828-324-9900
Mailing Address - Fax:
Practice Address - Street 1:24 2ND AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5045
Practice Address - Country:US
Practice Address - Phone:828-324-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010103592084P0800X
NC0010-10359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry