Provider Demographics
NPI:1427039031
Name:SANTOS, EMMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:SANTOS
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:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1221
Mailing Address - Country:US
Mailing Address - Phone:787-713-6505
Mailing Address - Fax:787-713-6511
Practice Address - Street 1:JUNCOS PLAZA, LOCAL D-2
Practice Address - Street 2:CARR. 31 JUNCOS A NAGUABO
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-713-6505
Practice Address - Fax:787-713-6511
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15076208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022526Medicare ID - Type Unspecified