Provider Demographics
NPI:1104825611
Name:SANTIAGO BUONO, UBALDO G (MD)
Entity Type:Individual
Prefix:
First Name:UBALDO
Middle Name:G
Last Name:SANTIAGO BUONO
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:J5 CALLE J
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2205
Mailing Address - Country:US
Mailing Address - Phone:787-722-2371
Mailing Address - Fax:787-722-2374
Practice Address - Street 1:1304 WILSON STREET
Practice Address - Street 2:COND EL VIGIA APT 8 S
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2243
Practice Address - Country:US
Practice Address - Phone:787-536-2033
Practice Address - Fax:787-722-2374
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13571207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020882OtherMEDICARE PTAN
PR7000006137OtherREMITANCE NO
PR7000006137OtherREMITANCE NO