Provider Demographics
NPI:1225142268
Name:FUENTES-SANTIAGO, YASMIN V (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:V
Last Name:FUENTES-SANTIAGO
Suffix:
Gender:F
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 738
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0738
Mailing Address - Country:US
Mailing Address - Phone:787-802-1771
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE CULTO
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1918
Practice Address - Country:US
Practice Address - Phone:787-802-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89542OtherBLUE SHIELD OF PR
PR100117OtherMMM
PR3654-6OtherPROSSAM
PRP367OtherFIRST MEDICAL
PR88484Medicare ID - Type Unspecified