Provider Demographics
NPI:1518028265
Name:SANTIAGO, ROSA E SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:E
Last Name:SANTIAGO
Suffix:SR
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:P.O BOX 10069
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-842-7931
Mailing Address - Fax:787-842-7953
Practice Address - Street 1:PONCE BYPASS
Practice Address - Street 2:EDEF PARRA SUITE 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-842-7931
Practice Address - Fax:787-842-7953
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89548Medicare ID - Type Unspecified
PR0089548Medicare UPIN