Healthcare Provider Details

I. General information

NPI: 1487647236
Provider Name (Legal Business Name): DIANA IDALIA SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PROGRESO #8 ALTOS
AGUADILLA PR
00603-5008
US

IV. Provider business mailing address

CALLE PROGRESO #14 PMB 55
AGUADILLA PR
00603-5008
US

V. Phone/Fax

Practice location:
  • Phone: 787-819-0194
  • Fax: 787-819-0194
Mailing address:
  • Phone: 787-819-0194
  • Fax: 787-819-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number6274
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: