Provider Demographics
NPI:1508197492
Name:ANDINO-VERGARA, SANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTA
Middle Name:
Last Name:ANDINO-VERGARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CALLE SAN LUIS
Mailing Address - Street 2:ESTANCIAS DE GRAN VISTA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5094
Mailing Address - Country:US
Mailing Address - Phone:787-764-9974
Mailing Address - Fax:
Practice Address - Street 1:566-B CALLE JUAN J. JIMENEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-764-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17811208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice