Provider Demographics
NPI:1497873327
Name:ERNESTO GARCIA SANTIAGO MD CSP
Entity Type:Organization
Organization Name:ERNESTO GARCIA SANTIAGO MD CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-704-0720
Mailing Address - Street 1:PMB 115 200 RAFAEL CORDERO
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-704-0720
Mailing Address - Fax:
Practice Address - Street 1:CALLE BETANCES NUM 141
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7250241OtherHUMANA HEALTH PLANS
PR400280OtherMEDICARE Y MUCHO MAS
PR89278OtherTRIPLE S SELECTO
PR060558OtherCRUZ AZUL DE PR
PR7250241OtherHUMANA HEALTH PLANS