Healthcare Provider Details

I. General information

NPI: 1003806324
Provider Name (Legal Business Name): KIYOMI M SANTOS ONODA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
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: 787-836-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8100
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: