Provider Demographics
NPI:1306003108
Name:SANTIAGO, MARIA LOURDES
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 BZN 77 FELIPE MENDEZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1127
Mailing Address - Country:US
Mailing Address - Phone:787-215-8529
Mailing Address - Fax:
Practice Address - Street 1:1-350 G NOEL ESTRADA AVE
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-1127
Practice Address - Country:US
Practice Address - Phone:787-872-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6708183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician