Provider Demographics
NPI:1003806324
Name:SANTOS ONODA, KIYOMI M (MD)
Entity Type:Individual
Prefix:DR
First Name:KIYOMI
Middle Name:M
Last Name:SANTOS ONODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10730
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0730
Mailing Address - Country:US
Mailing Address - Phone:787-836-3288
Mailing Address - Fax:787-836-3288
Practice Address - Street 1:602 CALLE JOSE V RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1807
Practice Address - Country:US
Practice Address - Phone:787-836-3288
Practice Address - Fax:866-626-2798
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029663Medicare ID - Type UnspecifiedMEDICARE NUMBER