Healthcare Provider Details

I. General information

NPI: 1003831611
Provider Name (Legal Business Name): LEOPOLDO SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CALLE ANTONIO R BARCELO
MAUNABO PR
00707-2142
US

IV. Provider business mailing address

PO BOX 1256
MAUNABO PR
00707-1256
US

V. Phone/Fax

Practice location:
  • Phone: 787-861-0901
  • Fax: 787-861-4411
Mailing address:
  • Phone: 787-861-0901
  • Fax: 787-861-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15017
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: