Healthcare Provider Details

I. General information

NPI: 1194987966
Provider Name (Legal Business Name): KALEM LINETTE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO SAN CRISTOBAL CALLE MUNOZ RIVERA #40
VILLALBA PUERTO RICO
00766
UM

IV. Provider business mailing address

1511 ALICANTE STREET, APT. 4
PONCE PUERTO RICO
00730
UM

V. Phone/Fax

Practice location:
  • Phone: 787-847-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17171
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: