MEDICARE: NANNETTE L. SANTIAGO BETANCOURT MD

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	19946	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19946	OTHER	PR	MEDICAL LICENSE

General Provider Information

NPI Number	:	1730673666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANNETTE L. SANTIAGO BETANCOURT MD

Provider Business Mailing Address
First Line	:	PO BOX 1357
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-1357
Country	:	US
Telephone Number	:	787-286-2800
Fax Number	:	787-286-2805

Provider Business Practice Location Address
First Line	:	3 MUNOZ RIVERA
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	787-286-2800
Fax Number	:	787-286-2805

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/07/2019

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