Provider Demographics
NPI:1407629181
Name:PEREZ SANTIAGO, KARLO RUBEN (MD)
Entity Type:Individual
Prefix:
First Name:KARLO
Middle Name:RUBEN
Last Name:PEREZ 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 1:712 CALLE FLAMBOYAN
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7577
Mailing Address - Country:US
Mailing Address - Phone:787-833-3366
Mailing Address - Fax:
Practice Address - Street 1:712 CALLE FLAMBOYAN
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7577
Practice Address - Country:US
Practice Address - Phone:787-833-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23547208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice