Provider Demographics
NPI:1083871354
Name:SANTIAGO, OSVALDO
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 8017
Mailing Address - Street 2:BO PAJAROS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-9740
Mailing Address - Country:US
Mailing Address - Phone:787-780-2054
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 8017
Practice Address - Street 2:BO PAJAROS
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-9740
Practice Address - Country:US
Practice Address - Phone:787-780-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3981183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician