Provider Demographics
NPI:1609820414
Name:GARCIA SANTIAGO, ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:GARCIA SANTIAGO
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:URB VILLA BLANCA
Mailing Address - Street 2:20 AVE. LMM STE 1 PMB 115
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1956
Mailing Address - Country:US
Mailing Address - Phone:787-961-4668
Mailing Address - Fax:787-523-2886
Practice Address - Street 1:AVENIDA LUIS MUNOZ MARIN
Practice Address - Street 2:HIMA PLAZA 1 SUITE 312
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00925-0000
Practice Address - Country:US
Practice Address - Phone:787-961-4668
Practice Address - Fax:787-961-4674
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400280OtherMEDICARE Y MUCHO MAS
PR1816OtherPREFERRED MEDICARE CHOICE
PR7250241OtherHUMANA HEALTH PLAN
PR7250241OtherHUMANA REFORMA
PR89278OtherTRIPLE S PROVIDER NUMBER
PR11611234OtherGLOBAL HEALTH
PR03187OtherAMERICAN HEALTH
PR060558OtherCRUZ AZUL DE PUERTO RICO
PR212855OtherPREFERRED HEALTH
PR9449OtherFIRST MEDICAL
PR4311239OtherUIA
PR7250241OtherHUMANA INSURANCE
PR7250241OtherHUMANA HEALTH PLAN
PR0083729Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER