MEDICARE: MRS. SONIA IVETTE SANTIAGO MATEO 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	9136	PR

General Provider Information

NPI Number	:	1992777262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONIA IVETTE SANTIAGO MATEO MD

Provider Business Mailing Address
First Line	:	PO BOX 9016
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-9016
Country	:	US
Telephone Number	:	787-843-7808
Fax Number	:	787-813-0798

Provider Business Practice Location Address
First Line	:	1935 AVENIDA LAS AMERICAS
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-1815
Country	:	US
Telephone Number	:	787-843-7808
Fax Number	:	787-813-0798

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	03/15/2010

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