Healthcare Provider Details

I. General information

NPI: 1669635041
Provider Name (Legal Business Name): MR. WILBUR JOSE SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 6 A-12 URB. LOMAS DEL SOL
GUAYNABO PR
00965
US

IV. Provider business mailing address

PO BOX 2183
SAN JUAN PR
00936-2183
US

V. Phone/Fax

Practice location:
  • Phone: 787-502-5512
  • Fax:
Mailing address:
  • Phone: 787-502-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: