Healthcare Provider Details

I. General information

NPI: 1093354664
Provider Name (Legal Business Name): MARIA ELISA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA PONCE DE LEON MCS PLAZA
SAN JUAN PR
00725
US

IV. Provider business mailing address

PO BOX 203
LA PLATA PR
00786-0203
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2500
  • Fax:
Mailing address:
  • Phone: 787-646-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3667
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: