Provider Demographics
NPI:1609016906
Name:SANTIAGO, JEANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:SANTIAGO
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:HC 02 BOX 8963
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00705
Mailing Address - Country:UM
Mailing Address - Phone:787-612-9587
Mailing Address - Fax:
Practice Address - Street 1:HC 02 BOX 8963
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00705
Practice Address - Country:UM
Practice Address - Phone:787-612-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist