Provider Demographics
NPI:1457327306
Name:SANTIAGO, ALLAN
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE POPPY B -74
Mailing Address - Street 2:PARQUE FORESTAL
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-721-7789
Mailing Address - Fax:787-725-5589
Practice Address - Street 1:29 CALLE WASHINGTON STE 705
Practice Address - Street 2:ASHFORD MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1521
Practice Address - Country:US
Practice Address - Phone:787-721-7789
Practice Address - Fax:787-725-5589
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7360207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD32348Medicare UPIN