Provider Demographics
NPI:1053511865
Name:SANTIAGO, BEATRIZ IVETTE
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:IVETTE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
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 1085
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1085
Mailing Address - Country:US
Mailing Address - Phone:787-849-4173
Mailing Address - Fax:787-849-4176
Practice Address - Street 1:CALLE DR RAMON E BETANCES S
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1729
Practice Address - Country:US
Practice Address - Phone:787-831-2212
Practice Address - Fax:787-805-3875
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6700183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician