Healthcare Provider Details

I. General information

NPI: 1306043781
Provider Name (Legal Business Name): CARMEN I SANTAELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PONCE DE LEON 1409 PISO 7
SAN JUAN PR
00936
US

IV. Provider business mailing address

PO BOX 51562 LEVITTOWN STA
TOA BAJA PR
00950-1562
US

V. Phone/Fax

Practice location:
  • Phone: 787-960-6818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number5658
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: