Provider Demographics
NPI:1275541534
Name:PEREZ SANTIAGO, GRISSELLE (MD)
Entity Type:Individual
Prefix:
First Name:GRISSELLE
Middle Name:
Last Name:PEREZ 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 1:101 CALLE PITIRRE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7100
Mailing Address - Country:US
Mailing Address - Phone:787-775-2685
Mailing Address - Fax:787-706-9112
Practice Address - Street 1:J16 CALLE 2 STE 110
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5045
Practice Address - Country:US
Practice Address - Phone:787-775-2685
Practice Address - Fax:787-706-9112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR128362081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG74204Medicare UPIN
0089637Medicare PIN