Healthcare Provider Details

I. General information

NPI: 1952539223
Provider Name (Legal Business Name): TANIA MARIE GONZALEZ SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIA GONZALEZ SANTIAGO MD

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 AVE GAUTIER BENITEZ CONSOLIDATED MEDICAL PLAZA (OFFICE 405A)
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 6106
CAGUAS PR
00726-6106
US

V. Phone/Fax

Practice location:
  • Phone: 787-246-3376
  • Fax: 939-355-0306
Mailing address:
  • Phone: 787-246-3376
  • Fax: 939-355-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number54430
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number105584
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberLT15015
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number22836
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: