Healthcare Provider Details

I. General information

NPI: 1518151877
Provider Name (Legal Business Name): JUAN GABRIEL SANTIAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CALLE MERCEDES MORENO
AGUADILLA PR
00603-5152
US

IV. Provider business mailing address

PO BOX 968
AGUADILLA PR
00605-0968
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-6370
  • Fax: 787-882-6373
Mailing address:
  • Phone: 787-882-6370
  • Fax: 787-882-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number17036
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberN4065
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17036
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: