MEDICARE: DR. LUIS ANTONIO 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	208D00000X	General Practice Physician	16244	PR

General Provider Information

NPI Number	:	1699746933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ANTONIO SANTIAGO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 561404
Second Line	:
City	:	GUAYANILLA
State	:	PR
Zip	:	00656-3404
Country	:	US
Telephone Number	:	787-209-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	BOB MACANA, SECTOR BOLERO
Second Line	:
City	:	GUAYANILLA
State	:	PR
Zip	:	00656
Country	:	US
Telephone Number	:	787-835-7178
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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