MEDICARE: RICARDO E. SANTIAGO 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	174400000X	Specialist	11830	PR
2	207U00000X	Nuclear Medicine Physician	11830	PR

General Provider Information

NPI Number	:	1710962204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO E. SANTIAGO M.D

Provider Business Mailing Address
First Line	:	PO BOX 3643
Second Line	:	AVE SEVERIANO CUEVAS 18, LOBBY HOSPITAL BUEN SAMARITANO
City	:	AGUADILLA
State	:	PR
Zip	:	00605-3643
Country	:	US
Telephone Number	:	787-882-1920
Fax Number	:	787-891-2175

Provider Business Practice Location Address
First Line	:	LOBBY HOSPITAL BUEN SAMARITANO
Second Line	:	AVE SEVERIANO CUEVAS 18
City	:	AGUADILLA
State	:	PR
Zip	:	00605
Country	:	US
Telephone Number	:	787-891-2175
Fax Number	:	787-891-2175

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	12/12/2011

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Directions to “ RICARDO E. SANTIAGO M.D” Practice Location

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