MEDICARE: MR. JOSE A SANTIAGO SANTIAGO 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	207R00000X	Internal Medicine Physician	8333	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE665Z	OTHER	PR	MEDICARE

General Provider Information

NPI Number	:	1891752440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE A SANTIAGO SANTIAGO MD

Provider Business Mailing Address
First Line	:	PO BOX 10730
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-0730
Country	:	US
Telephone Number	:	787-836-3288
Fax Number	:	866-626-2798

Provider Business Practice Location Address
First Line	:	602 CALLE JOSE V RODRIGUEZ
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624-1807
Country	:	US
Telephone Number	:	787-836-3288
Fax Number	:	866-626-2798

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	08/10/2022

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