Healthcare Provider Details

I. General information

NPI: 1063406643
Provider Name (Legal Business Name): DR. RAUL MARQUEZ SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE UNIVERSIDAD INTER #112
SAN GERMAN PR
00683
US

IV. Provider business mailing address

BOX 5000-349
SAN GERMAN PUERTO RICO
00683
UM

V. Phone/Fax

Practice location:
  • Phone: 787-264-0355
  • Fax: 787-264-0355
Mailing address:
  • Phone: 17872640355
  • Fax: 17872640355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number10595
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: