Provider Demographics
NPI:1619074960
Name:ULLOA RAMIREZ, SANTIAGO A
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:A
Last Name:ULLOA RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GONZALEZ GIUSTI AVENUE
Mailing Address - Street 2:CAPARRA GALLERY BLDG SUITE 305
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3017
Mailing Address - Country:US
Mailing Address - Phone:787-707-0095
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE GONZALEZ GIUSTI
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3017
Practice Address - Country:US
Practice Address - Phone:787-707-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH56417Medicare UPIN