Healthcare Provider Details

I. General information

NPI: 1912022310
Provider Name (Legal Business Name): WILLIAM O HURTADO-SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 AVE HOSTOS STE 201
MAYAGUEZ PR
00680-1507
US

IV. Provider business mailing address

357 AVE HOSTOS STE 203
MAYAGUEZ PR
00680-1535
US

V. Phone/Fax

Practice location:
  • Phone: 939-475-3432
  • Fax: 787-806-2239
Mailing address:
  • Phone: 787-677-7885
  • Fax: 787-806-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number16554
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: