Healthcare Provider Details

I. General information

NPI: 1891216313
Provider Name (Legal Business Name): ANNELISSE SANTIAGO PINTADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 CALLE TRINIDAD STE 102
SAN JUAN PR
00917-2900
US

IV. Provider business mailing address

983135 NEBRASKA MEDICAL CENTER UNIVERSITY OF NEBRASKA MEDICAL CENTER
OMAHA NE
69198-3135
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-5486
  • Fax: 787-268-4417
Mailing address:
  • Phone: 405-559-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number8033
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number22629
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: