Provider Demographics
NPI:1225121122
Name:SANTOS, ALBERTO SR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:SANTOS
Suffix:SR
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 800383
Mailing Address - Street 2:CALLE DEL PARQUE BLOQUE 1 SUITE 1
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0383
Mailing Address - Country:US
Mailing Address - Phone:787-848-1005
Mailing Address - Fax:787-840-8269
Practice Address - Street 1:CALLE DEL PARQUE BLOQUE 1
Practice Address - Street 2:SUITE 1 COTO LAUREL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780-0383
Practice Address - Country:US
Practice Address - Phone:787-848-1005
Practice Address - Fax:787-840-8269
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7179208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26228Medicare ID - Type Unspecified
D08361Medicare UPIN