Provider Demographics
NPI:1609897412
Name:SANTIAGO PEREZ, BASILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:BASILIO
Middle Name:
Last Name:SANTIAGO PEREZ
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 1:1668 CALLE SANTA BRIGIDA
Mailing Address - Street 2:SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4223
Mailing Address - Country:US
Mailing Address - Phone:787-210-9787
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-8369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8177207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101047448OtherLICENSE TO PRACTICE MED
PRF07578Medicare UPIN