Healthcare Provider Details

I. General information

NPI: 1346524717
Provider Name (Legal Business Name): SANTIAGO BUONO MEDICAL GROUP & HOSPITALIST SERVICES,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 AVE FERNANDEZ JUNCOS SUITE 204
SAN JUAN PR
00909-2658
US

IV. Provider business mailing address

1427 AVE FERNANDEZ JUNCOS SUITE 204
SAN JUAN PR
00909-2658
US

V. Phone/Fax

Practice location:
  • Phone: 787-562-5168
  • Fax:
Mailing address:
  • Phone: 787-722-9030
  • Fax: 787-722-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number301477
License Number StatePR

VIII. Authorized Official

Name: DR. UBALDO SANTIAGO
Title or Position: PRESIDENTE
Credential:
Phone: 787-562-5168