MEDICARE: SANTOS MANUEL SANTIAGO PABON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	022725	PR

General Provider Information

NPI Number	:	1205465119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTOS MANUEL SANTIAGO PABON MD

Provider Business Mailing Address
First Line	:	PO BOX 800378
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-0378
Country	:	US
Telephone Number	:	787-974-0815
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 BLVD LUIS A FERRE STE 207
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-2115
Country	:	US
Telephone Number	:	787-974-0815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	07/09/2025

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