Provider Demographics
NPI:1407238751
Name:SANTIAGO-ALICEA, GERARDO LUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:LUIS
Last Name:SANTIAGO-ALICEA
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 1:100 CALLE ALCALA APT 1702
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3928
Mailing Address - Country:US
Mailing Address - Phone:787-519-6526
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE SERGIO CUEVAS BUSTAMENTE, AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:787-763-9758
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19754208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice