Healthcare Provider Details

I. General information

NPI: 1780615138
Provider Name (Legal Business Name): NORMA EDITH SANTIAGO-RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA SURGICAL SERVICE (112)
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

220 PLAZA ADVANCE AUTO SUITE 101 PMB 225
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-4380
Mailing address:
  • Phone: 787-641-2975
  • Fax: 787-641-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11947
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: