Provider Demographics
NPI:1386650547
Name:MOJICA SANTIAGO, JOAQUIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:E
Last Name:MOJICA 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 605
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0605
Mailing Address - Country:US
Mailing Address - Phone:787-640-3379
Mailing Address - Fax:
Practice Address - Street 1:1420 CALLE AMERICO SALAS
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2139
Practice Address - Country:US
Practice Address - Phone:787-640-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5486363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE31476Medicare UPIN
PR0027806Medicare ID - Type Unspecified