MEDICARE: VICMARIE SANTIAGO NL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172P00000X	Naprapath	226	PR

General Provider Information

NPI Number	:	1003692765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICMARIE SANTIAGO NL

Provider Business Mailing Address
First Line	:	PO BOX 169
Second Line	:
City	:	CIALES
State	:	PR
Zip	:	00638-0169
Country	:	US
Telephone Number	:	787-548-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 AVE SIMON MADERA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-2232
Country	:	US
Telephone Number	:	787-250-0707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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Directions to “ VICMARIE SANTIAGO NL” Practice Location

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