Healthcare Provider Details

I. General information

NPI: 1033510748
Provider Name (Legal Business Name): MELVIN JAVIER SANTIAGO LIC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AC19 CALLE 30 REPARTO TERESITA BO. HATO TEJAS
BAYAMON PR
00961-8344
US

IV. Provider business mailing address

CALLE 30 AC 19 REPTO.TERESITA
BAYAMON PUERTO RICO
00961
UM

V. Phone/Fax

Practice location:
  • Phone: 787-972-7980
  • Fax:
Mailing address:
  • Phone: 787-972-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2200
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number2200
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number2200
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: