Healthcare Provider Details

I. General information

NPI: 1518028265
Provider Name (Legal Business Name): ROSA E SANTIAGO SR. MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/30/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

CAMINO DEL SUR GAVIOTA 465
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax: 939-229-1017
Mailing address:
  • Phone: 787-466-9821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11846
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number11846
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: