Provider Demographics
NPI:1104822949
Name:SANTIAGO GARCIA, NILDA (MD)
Entity Type:Individual
Prefix:DR
First Name:NILDA
Middle Name:
Last Name:SANTIAGO GARCIA
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0749
Mailing Address - Country:US
Mailing Address - Phone:787-259-8212
Mailing Address - Fax:787-848-7979
Practice Address - Street 1:EDIF PARRA SUITE 806
Practice Address - Street 2:2225 PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-259-8212
Practice Address - Fax:787-848-7979
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207R00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13174OtherLICENCE DOCTOR
PR90100Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRH82132Medicare UPIN