Healthcare Provider Details

I. General information

NPI: 1437233699
Provider Name (Legal Business Name): AURELIO SANTIAGO FORTIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CALLE ASHFORD N
GUAYAMA PR
00784-4608
US

IV. Provider business mailing address

PO BOX 670
GUAYAMA PR
00785-0670
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-6754
  • Fax:
Mailing address:
  • Phone: 787-864-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5484
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: