Healthcare Provider Details

I. General information

NPI: 1023565488
Provider Name (Legal Business Name): MEREDID SIGMAR MALDONADO- SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VILLAS DEL RIO
UTUADO PR
00641
US

IV. Provider business mailing address

8 VILLAS DEL RIO
UTUADO PR
00641
US

V. Phone/Fax

Practice location:
  • Phone: 787-360-7622
  • Fax:
Mailing address:
  • Phone: 787-360-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number22195
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: