Provider Demographics
NPI:1083654784
Name:SANTIAGO, ROSANGEL (MD)
Entity Type:Individual
Prefix:
First Name:ROSANGEL
Middle Name:
Last Name:SANTIAGO
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:CONDOMINIO PRIMAVERA
Mailing Address - Street 2:APT 722 BOX 40
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4803
Mailing Address - Country:US
Mailing Address - Phone:787-452-0574
Mailing Address - Fax:
Practice Address - Street 1:1313 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1252
Practice Address - Country:US
Practice Address - Phone:786-491-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN493208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice