MEDICARE: DR. KIYOMI M SANTOS ONODA M.D.

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	208D00000X	General Practice Physician	8100	PR

General Provider Information

NPI Number	:	1003806324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIYOMI M SANTOS ONODA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10730
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-0730
Country	:	US
Telephone Number	:	787-836-3288
Fax Number	:	787-836-3288

Provider Business Practice Location Address
First Line	:	602 CALLE JOSE V RODRIGUEZ
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624-1807
Country	:	US
Telephone Number	:	787-836-3288
Fax Number	:	866-626-2798

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/10/2022

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