Healthcare Provider Details

I. General information

NPI: 1932022258
Provider Name (Legal Business Name): KESSIA IRIS HERNANDEZ SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DEL PARQUE 733 CALLE CAOBA L10
JUANA DIAZ PR
00795-6511
US

IV. Provider business mailing address

PASEO DEL PARQUE 733 CALLE CAOBA L10
JUANA DIAZ PR
00795-6511
US

V. Phone/Fax

Practice location:
  • Phone: 939-252-2301
  • Fax:
Mailing address:
  • Phone: 939-252-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17856
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: