Provider Demographics
NPI:1346233830
Name:SANTOS ONODA, MARYLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYLYN
Middle Name:
Last Name:SANTOS ONODA
Suffix:
Gender:F
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 7999
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7999
Mailing Address - Country:US
Mailing Address - Phone:787-833-2085
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE PABLO MAIZ
Practice Address - Street 2:BO. BARCELONA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4838
Practice Address - Country:US
Practice Address - Phone:787-805-4330
Practice Address - Fax:787-805-5990
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207R000000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF39973Medicare UPIN
PR83280Medicare ID - Type Unspecified