Provider Demographics
NPI:1477673192
Name:SANTINI RODRIGUEZ, GLENDA DAMARIS
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:DAMARIS
Last Name:SANTINI RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. SANTA ANA SUR
Mailing Address - Street 2:APT 20-A
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-238-0111
Mailing Address - Fax:787-763-0676
Practice Address - Street 1:AVE 830 KM0.1 BARRIO CERRO GORDO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-730-3653
Practice Address - Fax:787-730-9545
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR448152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist