Provider Demographics
NPI:1417067976
Name:SANTIAGO, ENID
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 CALLE LOS TULIPANES
Mailing Address - Street 2:URB EL VALLE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3230
Mailing Address - Country:US
Mailing Address - Phone:787-370-0203
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA LURS MUNOZ MAVIN URB EAGUAX
Practice Address - Street 2:C1 BO TOMAJ DE CASTRO
Practice Address - City:CEGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist