Provider Demographics
NPI:1346004520
Name:SANTIAGO RODRIGUEZ, EDWIN ALBERTO (CHT & CHWS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:ALBERTO
Last Name:SANTIAGO RODRIGUEZ
Suffix:
Gender:M
Credentials:CHT & CHWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPARTO ESPERANZA CALLE LUIS LLORENS TORRES P23
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:939-202-3265
Mailing Address - Fax:
Practice Address - Street 1:CARR. 315 KM 1.0 AVE. FLAMBOYANES INTERIOR INTERSECCIO
Practice Address - Street 2:AVE. 65 INFANTERIA
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00647
Practice Address - Country:US
Practice Address - Phone:939-202-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25622083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine