Healthcare Provider Details

I. General information

NPI: 1841846516
Provider Name (Legal Business Name): YARELIS MARIE DUMENG SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 07/26/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALLE DR BASORA N
MAYAGUEZ PR
00680-4833
US

IV. Provider business mailing address

PO BOX 533
ISABELA PR
00662-0533
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-0101
  • Fax:
Mailing address:
  • Phone: 787-629-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22250
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34104R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: