Provider Demographics
NPI:1477560225
Name:SANTA-GOMEZ, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:SANTA-GOMEZ
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 1:85 PASEO
Mailing Address - Street 2:GRAN VISTA 1
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-743-9594
Mailing Address - Fax:
Practice Address - Street 1:115 CALLE JAZMIN
Practice Address - Street 2:CONDADO VIEJO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-743-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR80122084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9-9606OtherPROVIDER
PRD08804Medicare UPIN