Healthcare Provider Details

I. General information

NPI: 1386642825
Provider Name (Legal Business Name): MAGALY SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELISA TAVAREZ HC 17 7MA SECCION
TOA BAJA PR
00949
US

IV. Provider business mailing address

ELISA TAVAREZ HC 17 7MA SECCION
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-0029
  • Fax:
Mailing address:
  • Phone: 787-261-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9376
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: