Provider Demographics
NPI:1386817369
Name:GONZALEZ-SANTIAGO, MARIANA (MT)
Entity Type:Individual
Prefix:MS
First Name:MARIANA
Middle Name:
Last Name:GONZALEZ-SANTIAGO
Suffix:
Gender:F
Credentials:MT
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 2488
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-2488
Mailing Address - Country:US
Mailing Address - Phone:787-794-2240
Mailing Address - Fax:787-794-2240
Practice Address - Street 1:40 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2443
Practice Address - Country:US
Practice Address - Phone:787-794-2240
Practice Address - Fax:787-794-2240
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1906246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030489Medicare PIN