Provider Demographics
NPI:1033510748
Name:SANTIAGO, MELVIN JAVIER (LIC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:JAVIER
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 30
Mailing Address - Street 2:AC 19 REPTO.TERESITA
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00961
Mailing Address - Country:UM
Mailing Address - Phone:787-972-7980
Mailing Address - Fax:
Practice Address - Street 1:AC19 CALLE 30
Practice Address - Street 2:REPARTO TERESITA BO. HATO TEJAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-8344
Practice Address - Country:US
Practice Address - Phone:787-972-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2200227900000X, 2279E1000X, 2279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist