MEDICARE: DR. JOAQUIN E MOJICA SANTIAGO M.D.

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	363AS0400X	Surgical Physician Assistant	5486	PR

General Provider Information

NPI Number	:	1386650547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAQUIN E MOJICA SANTIAGO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 605
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00792-0605
Country	:	US
Telephone Number	:	787-640-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 CALLE AMERICO SALAS
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00909-2139
Country	:	US
Telephone Number	:	787-640-3379
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	06/11/2010

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