Healthcare Provider Details

I. General information

NPI: 1336124627
Provider Name (Legal Business Name): ELFREN F. RIOS SANTIAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MENDEZ VIGO #275
DORADO PR
00646-4904
US

IV. Provider business mailing address

MENDEZ VIGO #275
DORADO PR
00646-4904
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-6154
  • Fax: 787-278-5769
Mailing address:
  • Phone: 787-796-6154
  • Fax: 787-278-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7399
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number62
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: