Provider Demographics
NPI:1245228147
Name:SANTIAGO, ALBERTO J (OD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:J
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 58950
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9775
Mailing Address - Country:US
Mailing Address - Phone:787-898-3398
Mailing Address - Fax:787-898-3398
Practice Address - Street 1:CARRETERA 129 KM 15.1 BO. BAYANEY
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-3398
Practice Address - Fax:787-898-3398
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64025Medicare UPIN
PR58145Medicare ID - Type Unspecified