Provider Demographics
NPI:1306817911
Name:ROSADO SANTIAGO, MILJAN I (MD)
Entity Type:Individual
Prefix:MISS
First Name:MILJAN
Middle Name:I
Last Name:ROSADO SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5435
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-9712
Mailing Address - Country:US
Mailing Address - Phone:787-882-0570
Mailing Address - Fax:787-882-0680
Practice Address - Street 1:ST # 2 KM. 118.9 BO. CEIBABAJA
Practice Address - Street 2:AGUADILLA , PUERTO RICO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-0570
Practice Address - Fax:787-882-0680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0114062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89846Medicare ID - Type UnspecifiedPROVIDER #