Healthcare Provider Details

I. General information

NPI: 1952786220
Provider Name (Legal Business Name): SANTIAGO BUONO ER SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 CALLE WILSON COND EL VIGIA APT 8 SUR
SAN JUAN PR
00907
US

IV. Provider business mailing address

1304 CALLE WILSON COND EL VIGIA APT 8 SUR
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-3444
  • Fax:
Mailing address:
  • Phone: 787-721-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. UBALDO G SANTIAGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-721-3444