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General NPI Number Information
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NPI Number | 1003955501
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Entity Type | Individual
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Provider Name | AIDA M LIZASOAIN SANTIAGO MD
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 1056 CALLE FERROCARRIL SUITE 1
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City | RIO PIEDRAS
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State | PR
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Zip | 00925-3028
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Country | US
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Telephone | 787-764-8937
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Fax | 787-767-4763
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Provider Business Mailing Address
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Address Line | 1056 CALLE FERROCARRIL SUITE 1
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City | RIO PIEDRAS
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State | PR
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Zip | 00925-3028
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Country | US
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Telephone | 787-764-8937
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Fax | 787-767-4763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 12922
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License Number State | PR
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