Provider Demographics
NPI:1164752325
Name:SANTIAGO, ADENITTE (7218)
Entity Type:Individual
Prefix:
First Name:ADENITTE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:7218
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HX-01 BOX 5206
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00688
Mailing Address - Country:UM
Mailing Address - Phone:787-454-0977
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 5206
Practice Address - Street 2:
Practice Address - City:SABANA HOYOS
Practice Address - State:PR
Practice Address - Zip Code:00688-8719
Practice Address - Country:US
Practice Address - Phone:787-454-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7218183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician