Healthcare Provider Details

I. General information

NPI: 1104822949
Provider Name (Legal Business Name): NILDA SANTIAGO GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 AVE. FERROCARRIL SUITE #17
PONCE PR
00717
US

IV. Provider business mailing address

471 AVE. FERROCARRIL SUITE 135
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-8212
  • Fax: 787-848-7979
Mailing address:
  • Phone: 787-259-8212
  • Fax: 787-848-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207R00000X
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: