Provider Demographics
NPI:1083772792
Name:MARRERO SANTIAGO, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:MARRERO SANTIAGO
Suffix:
Gender:M
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:MARTINETE 153
Mailing Address - Street 2:MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00926
Mailing Address - Country:UM
Mailing Address - Phone:787-244-8214
Mailing Address - Fax:
Practice Address - Street 1:JOSE MARTI #57
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:917
Practice Address - Country:UM
Practice Address - Phone:787-244-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5411208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMO603107OtherSSS
PR27114Medicare ID - Type Unspecified