Healthcare Provider Details

I. General information

NPI: 1063473650
Provider Name (Legal Business Name): MARIA L. SANTAELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C18 CALLE TULANE URB. SANTA ANA
SAN JUAN PR
00927-4903
US

IV. Provider business mailing address

C18 CALLE TULANE URB. SANTA ANA
SAN JUAN PR
00927-4903
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-764-6839
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-764-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4404
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: