Provider Demographics
NPI:1619190626
Name:TELLO SANTINI, CARMINIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CARMINIA
Middle Name:
Last Name:TELLO SANTINI
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 1:40 CALLE 10
Mailing Address - Street 2:COND. TORRIMAR PLAZA APT. 9A
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3207
Mailing Address - Country:US
Mailing Address - Phone:787-370-4824
Mailing Address - Fax:787-790-8805
Practice Address - Street 1:40 CALLE 10
Practice Address - Street 2:COND. TORRIMAR PLAZA APT. 9A
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3207
Practice Address - Country:US
Practice Address - Phone:787-370-4824
Practice Address - Fax:787-790-8805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11353208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023308Medicare ID - Type UnspecifiedPROVIDER NUMBER