Provider Demographics
NPI:1568459758
Name:JOAQUIN, SANTIAGO (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:JOAQUIN
Suffix:
Gender:M
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:MANSION DEL SUR
Mailing Address - Street 2:PLAZA 3 SA 57
Mailing Address - City:LEVITTOWN
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-784-5653
Mailing Address - Fax:
Practice Address - Street 1:SA57 PLAZA 3
Practice Address - Street 2:MANSION DEL SUR
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4850
Practice Address - Country:US
Practice Address - Phone:787-784-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9030208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF18828Medicare UPIN
PR87603Medicare ID - Type Unspecified