Provider Demographics
NPI:1346243722
Name:SANTINI SANTIAGO, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:SANTINI SANTIAGO
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 192529
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2529
Mailing Address - Country:US
Mailing Address - Phone:787-764-0738
Mailing Address - Fax:787-764-8039
Practice Address - Street 1:DE DIEGO APT 368
Practice Address - Street 2:COND CRYSTAL HOUSE
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00923-3054
Practice Address - Country:US
Practice Address - Phone:787-764-0738
Practice Address - Fax:787-764-8039
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6636207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79736Medicare UPIN
PR28257Medicare PIN
PR0028257Medicare PIN