Healthcare Provider Details

I. General information

NPI: 1780667089
Provider Name (Legal Business Name): VIRGILIO CORA SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON 125
AGUADA PR
00602
US

IV. Provider business mailing address

PMB7999 BOX 120
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-0000
  • Fax:
Mailing address:
  • Phone: 787-868-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6599
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: