MEDICARE: MRS. LIZETTE 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	207Q00000X	Family Medicine Physician	11180	PR

General Provider Information

NPI Number	:	1710986070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZETTE SANTIAGO M.D.

Provider Business Mailing Address
First Line	:	1306 AVE FERNANDEZ JUNCOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2521
Country	:	US
Telephone Number	:	787-723-2424
Fax Number	:	787-724-5104

Provider Business Practice Location Address
First Line	:	1306 AVE FERNANDEZ JUNCOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2521
Country	:	US
Telephone Number	:	787-723-2424
Fax Number	:	787-724-5104

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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