Healthcare Provider Details

I. General information

NPI: 1386488609
Provider Name (Legal Business Name): LUIS MANUEL SANTIAGO RN BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DR. JOSE CELSO BARBOSA UNIVERSIDAD DE PUERTO RICO RECINTO DE CIENCIAS MEDICAS
SAN JUAN PR
00921
US

IV. Provider business mailing address

HC 2 BOX 71098 BO PALOMAS
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 708-782-4290
Mailing address:
  • Phone: 787-367-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberG-92245
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: