Healthcare Provider Details

I. General information

NPI: 1245329465
Provider Name (Legal Business Name): JOSUE MANUEL SANTANA R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DEL VETERANO 1010
PONCE PR
00716-2001
US

IV. Provider business mailing address

PO BOX 6115
MAYAGUEZ PR
00681-6115
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax:
Mailing address:
  • Phone: 787-422-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number1505
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: