Healthcare Provider Details

I. General information

NPI: 1275047052
Provider Name (Legal Business Name): GREISHA MARIE GONZALEZ SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CALLE BEATO FRANCISCO PALAU
PONCE PR
00728-1908
US

IV. Provider business mailing address

CARR 435 KM 3.3 INT
SAN SEBASTIAN PR
00685
US

V. Phone/Fax

Practice location:
  • Phone: 787-421-2747
  • Fax:
Mailing address:
  • Phone: 787-421-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number22239
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22239
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: