Healthcare Provider Details

I. General information

NPI: 1497048482
Provider Name (Legal Business Name): WANDA L. SANTIAGO-PEREZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PASEO TRIO VEGABAJENO TORREVISTA 995
VEGA BAJA PR
00693-5831
US

IV. Provider business mailing address

210 PASEO TRIO VEGABAJENO TORREVISTA 995
VEGA BAJA PR
00693-5831
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-3004
  • Fax: 787-855-3301
Mailing address:
  • Phone: 787-855-3004
  • Fax: 787-855-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3950
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: