Provider Demographics
NPI:1447603055
Name:SANTIAGO SANTANA, OCTAVIO (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:
Last Name:SANTIAGO SANTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OCTAVIO
Other - Middle Name:
Other - Last Name:SANTIAGO SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19869
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 CALLE PAVIA STE 204205
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2239
Practice Address - Country:US
Practice Address - Phone:787-727-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70917207V00000X
PR23252207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology