Healthcare Provider Details

I. General information

NPI: 1568459758
Provider Name (Legal Business Name): SANTIAGO JOAQUIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SA57 PLAZA 3 MANSION DEL SUR
TOA BAJA PR
00949-4850
US

IV. Provider business mailing address

MANSION DEL SUR PLAZA 3 SA 57
LEVITTOWN PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-5653
  • Fax:
Mailing address:
  • Phone: 787-784-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9030
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: