Provider Demographics
NPI:1558322826
Name:SANTIAGO, GUADALUPE SANTIAGO
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:SANTIAGO
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140662
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0662
Mailing Address - Country:US
Mailing Address - Phone:787-879-3978
Mailing Address - Fax:787-880-3789
Practice Address - Street 1:NUM 50 AVE TRINA PADILLA DE SANZ
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4503
Practice Address - Country:US
Practice Address - Phone:787-879-3978
Practice Address - Fax:787-880-3789
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine