Healthcare Provider Details

I. General information

NPI: 1700341690
Provider Name (Legal Business Name): NATASHA NICOLE SANTIAGO SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 CALLE AVILA
PONCE PR
00730-4026
US

IV. Provider business mailing address

1154 CALLE AVILA URB LA RAMBLA
PONCE PR
00730-4026
US

V. Phone/Fax

Practice location:
  • Phone: 787-718-0828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24338
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: