Healthcare Provider Details

I. General information

NPI: 1063490100
Provider Name (Legal Business Name): VANESSA SANTINI HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE GONZALEZ GUISTI #107 STE 205, CAPARRA GALLERY PLAZA
GUAYNABO PR
00966
US

IV. Provider business mailing address

690 CESAR GONZALEZ APT 1801, COND PARGUE DE LAS FUENTES
SAN JUAN PR
00918-3905
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-0745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6174
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: