Healthcare Provider Details

I. General information

NPI: 1548815681
Provider Name (Legal Business Name): MIGUEL ANGEL SANTIAGO CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 65 DE INFANTERIA KM 12.3
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 190990
SAN JUAN PR
00919-0990
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-2477
  • Fax: 787-276-0065
Mailing address:
  • Phone: 787-769-2477
  • Fax: 787-276-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number24642
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number24642
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: