Healthcare Provider Details

I. General information

NPI: 1851373369
Provider Name (Legal Business Name): JOSE D SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL SAN LUCAS #CARR 14
PONCE PR
00716
US

IV. Provider business mailing address

609 AVE TITO CASTRO STE 102
PONCE PR
00716-2232
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-4883
  • Fax: 787-842-4883
Mailing address:
  • Phone: 787-842-4883
  • Fax: 787-842-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number8479
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: