Healthcare Provider Details

I. General information

NPI: 1376578021
Provider Name (Legal Business Name): CARMEN MARIA SANTIAGO CANDELARIA 19835
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 CALLE ALDA STE 201 URB. CARIBE
SAN JUAN PR
00926-2709
US

IV. Provider business mailing address

PO BOX 350
CAMUY PR
00627-0350
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-0810
  • Fax:
Mailing address:
  • Phone: 787-262-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number19835
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: