Provider Demographics
NPI:1619071859
Name:SANTIAGO-SANTIAGO, JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:SANTIAGO-SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:SANTIAGO-SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:363 CALLE JOSE M ESPINOSA
Mailing Address - Street 2:BORIQUEN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6324
Mailing Address - Country:US
Mailing Address - Phone:787-602-3072
Mailing Address - Fax:
Practice Address - Street 1:363 CALLE JOSE M ESPINOSA
Practice Address - Street 2:BORIQUEN GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6324
Practice Address - Country:US
Practice Address - Phone:787-602-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14403207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14403OtherSTATE LICENSE PR