Healthcare Provider Details

I. General information

NPI: 1326024126
Provider Name (Legal Business Name): VIRGINIA MARGARITA SANTIAGO MERCADO BSMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 AVE DOMENECH
SAN JUAN PR
00918-3708
US

IV. Provider business mailing address

369 DOMENECH AVE.
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-2556
  • Fax: 787-758-0308
Mailing address:
  • Phone: 787-765-2556
  • Fax: 787-758-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number315
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: