Healthcare Provider Details

I. General information

NPI: 1871964494
Provider Name (Legal Business Name): ERNESTO SANTINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 336810
PONCE PR
00733
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-1327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32106R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: