Provider Demographics
NPI:1386867497
Name:RAFAEL M. SANTIAGO, M.D.
Entity Type:Organization
Organization Name:RAFAEL M. SANTIAGO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:CALDAS
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-481-3119
Mailing Address - Street 1:225 E SONTERRA BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3886
Mailing Address - Country:US
Mailing Address - Phone:210-481-3119
Mailing Address - Fax:210-497-2071
Practice Address - Street 1:225 E SONTERRA BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3886
Practice Address - Country:US
Practice Address - Phone:210-481-3119
Practice Address - Fax:210-497-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE03407Medicare UPIN
TX00716VMedicare ID - Type Unspecified