Provider Demographics
NPI:1134283583
Name:SANTIAGO, DORIS
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JA12 CALLE ANTONIO EGIPCIACO
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3702
Mailing Address - Country:US
Mailing Address - Phone:787-784-3378
Mailing Address - Fax:
Practice Address - Street 1:JA12 CALLE ANTONIO EGIPCIACO
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3702
Practice Address - Country:US
Practice Address - Phone:787-784-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist