Healthcare Provider Details

I. General information

NPI: 1891752440
Provider Name (Legal Business Name): JOSE A SANTIAGO SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 CALLE JOSE V RODRIGUEZ
PENUELAS PR
00624-1807
US

IV. Provider business mailing address

PO BOX 10730
PONCE PR
00732-0730
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-3288
  • Fax: 866-626-2798
Mailing address:
  • Phone: 787-836-3288
  • Fax: 866-626-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8333
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: