Provider Demographics
NPI:1346524717
Name:SANTIAGO BUONO MEDICAL GROUP & HOSPITALIST SERVICES,PSC
Entity Type:Organization
Organization Name:SANTIAGO BUONO MEDICAL GROUP & HOSPITALIST SERVICES,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:UBALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-562-5168
Mailing Address - Street 1:1427 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2658
Mailing Address - Country:US
Mailing Address - Phone:787-722-9030
Mailing Address - Fax:787-722-9049
Practice Address - Street 1:1427 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2658
Practice Address - Country:US
Practice Address - Phone:787-562-5168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR301477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR301477OtherCERTIFICACION