Provider Demographics
NPI:1013019892
Name:SANTIAGO GONZALEZ, MARISEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISEL
Middle Name:
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISEL
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21444 CARMEAN WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4572
Mailing Address - Country:US
Mailing Address - Phone:302-855-1233
Mailing Address - Fax:302-855-2025
Practice Address - Street 1:21444 CARMEAN WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4572
Practice Address - Country:US
Practice Address - Phone:302-855-2020
Practice Address - Fax:302-855-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10609174400000X
DEC1-0009135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200111611Medicaid