Healthcare Provider Details

I. General information

NPI: 1619074960
Provider Name (Legal Business Name): SANTIAGO A ULLOA RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALLE GONZALEZ GIUSTI
GUAYNABO PR
00968-3017
US

IV. Provider business mailing address

107 GONZALEZ GIUSTI AVENUE CAPARRA GALLERY BLDG SUITE 305
GUAYNABO PR
00968-3017
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-0095
  • Fax:
Mailing address:
  • Phone: 787-707-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10722
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: