Healthcare Provider Details

I. General information

NPI: 1760433007
Provider Name (Legal Business Name): FELISA SANTIAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 CALLE PARANA
SAN JUAN PR
00926-3142
US

IV. Provider business mailing address

1645 CALLE PARANA
SAN JUAN PR
00926-3142
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-8164
  • Fax: 787-754-1564
Mailing address:
  • Phone: 787-764-8164
  • Fax: 787-754-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3829
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: