Provider Demographics
NPI:1770926750
Name:ALMANZAR DISLA, SANTIAGO ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:ALBERTO
Last Name:ALMANZAR DISLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8502
Mailing Address - Country:US
Mailing Address - Phone:814-226-9545
Mailing Address - Fax:
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8502
Practice Address - Country:US
Practice Address - Phone:814-226-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4498632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry