Provider Demographics
NPI:1164404489
Name:SANTOS, JOSE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DAVID
Last Name:SANTOS
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0084
Mailing Address - Country:US
Mailing Address - Phone:787-737-4659
Mailing Address - Fax:787-737-1384
Practice Address - Street 1:CALLE SAN JOSE 52
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-4659
Practice Address - Fax:787-737-1384
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16117208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0002-3775Medicare UPIN