Healthcare Provider Details

I. General information

NPI: 1356727101
Provider Name (Legal Business Name): LLOYD M SANTIAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

5205 CONGRESS AVE APT 239
BOCA RATON FL
33487-3791
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-4440
  • Fax:
Mailing address:
  • Phone: 787-439-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19789
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13797-I
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number161737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: