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General NPI Number Information
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NPI Number | 1952539223
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Entity Type | Individual
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Provider Name | TANIA MARIE GONZALEZ SANTIAGO MD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 201 AVE GAUTIER BENITEZ CONSOLIDATED MEDICAL PLAZA (OFFICE 405A)
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-246-3376
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Fax | 939-355-0306
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Provider Business Mailing Address
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Address Line | PO BOX 6106
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City | CAGUAS
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State | PR
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Zip | 00726-6106
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Country | US
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Telephone | 787-246-3376
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Fax | 939-355-0306
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 54430
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 105584
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | LT15015
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 22836
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License Number State | PR
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