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NPI Code Detail

MEDICARE: NYDIA I SANTIAGO GONZALES AVD

MEDICARE:   NYDIA I SANTIAGO GONZALES  AVD
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
1231H00000XAudiologist023PR

General Provider Information

NPI Number : 1255410528
Entity Type Code : Individual
Provider Name (Legal Business Name) : NYDIA I SANTIAGO GONZALES AVD
Provider Business Mailing Address
First Line : EDIF CADILLA 100 PASEO SAN PABLO
Second Line : SUITE 412
City : BAYAMON
State : PR
Zip : 00961-7028
Country : US
Telephone Number : 787-798-5000
Fax Number : 787-798-5028
Provider Business Practice Location Address
First Line : EDIFICIO ARTURO CADILLA
Second Line : SUITE 412 HIMA SAN PABLO
City : BAYAMON
State : PR
Zip : 00961-7028
Country : US
Telephone Number : 787-798-5000
Fax Number : 787-798-5028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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Practice Location Address:
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Directions to “ NYDIA I SANTIAGO GONZALES AVD” Practice Location

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