Healthcare Provider Details

I. General information

NPI: 1023292638
Provider Name (Legal Business Name): DAGMAR L SANTIAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 CONCORDIA EDIF.PROFESIONAL STE 2
PONCE PR
00717-1552
US

IV. Provider business mailing address

8151 CONCORDIA EDIF.PROFESIONAL STE 2
PONCE PR
00717-1552
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-1272
  • Fax: 787-840-0985
Mailing address:
  • Phone: 787-842-1272
  • Fax: 787-840-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DAGMAR L SANTIAGO
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-842-1272