Healthcare Provider Details

I. General information

NPI: 1285763144
Provider Name (Legal Business Name): ALBERTO SANTIAGO CORNIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 SAN JORGE STREET SUITE 408
SANTURCE PR
00912-0000
US

IV. Provider business mailing address

PO BOX 87
MAYAGUEZ PR
00681-0087
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-8316
  • Fax: 787-728-8316
Mailing address:
  • Phone: 787-728-8316
  • Fax: 787-728-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number11117
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: