Healthcare Provider Details

I. General information

NPI: 1528171261
Provider Name (Legal Business Name): FIDEL SANTOS - SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE PLAZA LAS AMERICAS SUITE 1210 525 AVE FD ROOSEVELT
SAN JUAN PR
00918
US

IV. Provider business mailing address

98 CALLE 1 PASEO LAS VISTAS
SAN JUAN PR
00926-5943
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-3326
  • Fax: 787-758-7562
Mailing address:
  • Phone: 787-397-7188
  • Fax: 787-777-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6545
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number6545
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: