Healthcare Provider Details

I. General information

NPI: 1497883615
Provider Name (Legal Business Name): ANA M RODRIGUEZ SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIO DEL PLATA MALL OFICINA 12 B
TOA ALTA PR
00953
US

IV. Provider business mailing address

PO BOX 591
COMERIO PR
00782-0591
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-4069
  • Fax: 787-870-4725
Mailing address:
  • Phone: 787-730-1562
  • Fax: 787-870-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10399
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: