Provider Demographics
NPI:1467490706
Name:HERNANDEZ SANTIAGO, MILTON
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:HERNANDEZ 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:PO BOX 70012
Mailing Address - Street 2:PMB 1165
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7012
Mailing Address - Country:US
Mailing Address - Phone:787-863-2942
Mailing Address - Fax:787-860-6459
Practice Address - Street 1:AVENIDA PRINCIPAL E3
Practice Address - Street 2:URB BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-2942
Practice Address - Fax:787-860-6459
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR316111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0035113Medicare ID - Type Unspecified