Provider Demographics
NPI:1346218310
Name:SANTIAGOALICEA, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:SANTIAGOALICEA
Suffix:
Gender:M
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:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0481
Mailing Address - Country:US
Mailing Address - Phone:787-834-2429
Mailing Address - Fax:787-834-2429
Practice Address - Street 1:63 MENDEZ VIGO E
Practice Address - Street 2:1B
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4972
Practice Address - Country:US
Practice Address - Phone:787-834-2429
Practice Address - Fax:787-834-2429
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8356207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66627Medicare UPIN