Provider Demographics
NPI:1477536498
Name:MATOS-SANTIAGO, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MATOS-SANTIAGO
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 1:525 AVE. F.D. ROOSEVELT
Mailing Address - Street 2:SUITE 607
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-8052
Mailing Address - Country:US
Mailing Address - Phone:787-756-7730
Mailing Address - Fax:787-754-2472
Practice Address - Street 1:LA TORRE DE PLAZA LAS AMERICAS
Practice Address - Street 2:SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-756-7730
Practice Address - Fax:787-754-2472
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3572207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78061Medicare UPIN