Provider Demographics
NPI:1326427980
Name:SANTIAGO, MARTIN
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D32 CALLE JADE
Mailing Address - Street 2:URB LA PLATA
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4827
Mailing Address - Country:US
Mailing Address - Phone:787-307-5615
Mailing Address - Fax:
Practice Address - Street 1:D32 CALLE JADE
Practice Address - Street 2:URB LA PLATA
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4827
Practice Address - Country:US
Practice Address - Phone:787-307-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR52659-G163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse