Healthcare Provider Details

I. General information

NPI: 1053097865
Provider Name (Legal Business Name): JONATHAN IVAN SANTOS BERRIOS RN BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO VIG TOWER PISO 1 PONCE DE LEON AVE. #1225
SANTURCE PR
00936
US

IV. Provider business mailing address

RR 1 BOX 2964
CIDRA PR
00739
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-0773
  • Fax:
Mailing address:
  • Phone: 787-930-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number98209
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: