Provider Demographics
NPI:1164011714
Name:SANTIAGO, WILBERTO CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:WILBERTO
Middle Name:CARLOS
Last Name: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 1:153 AVE JOSE DE DIEGO E
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-3847
Mailing Address - Country:US
Mailing Address - Phone:787-738-4539
Mailing Address - Fax:
Practice Address - Street 1:153 AVE JOSE DE DIEGO E
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3847
Practice Address - Country:US
Practice Address - Phone:787-738-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice