Provider Demographics
NPI:1588646681
Name:SANTIAGO SANCHEZ, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:SANTIAGO SANCHEZ
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:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0633
Mailing Address - Country:US
Mailing Address - Phone:787-784-5706
Mailing Address - Fax:787-795-0952
Practice Address - Street 1:1000 AVE DOS PALMAS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4101
Practice Address - Country:US
Practice Address - Phone:787-787-5706
Practice Address - Fax:787-795-0952
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10298208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88505Medicare ID - Type Unspecified
G41210Medicare UPIN