Healthcare Provider Details

I. General information

NPI: 1366444689
Provider Name (Legal Business Name): CHARLES JUARBE SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 EDIF MEDICO SANTA CRUZ SUITE 205
BAYAMON PR
00961
US

IV. Provider business mailing address

EDIFICIO MEDICO STA CRUZ 73 SUITE 205
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-1120
  • Fax: 787-269-1565
Mailing address:
  • Phone: 787-740-1120
  • Fax: 787-269-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5777
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: