Healthcare Provider Details

I. General information

NPI: 1174678247
Provider Name (Legal Business Name): JOSE R SANTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST 11 BLG 33 #22 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

BOX 30819 65TH INF STATION
SAN JUAN PR
00929
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-1630
  • Fax: 787-769-1630
Mailing address:
  • Phone: 787-667-3446
  • Fax: 787-769-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8760
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number8760
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: