Provider Demographics
NPI:1619499530
Name:QUILES GUZMAN, SANTIAGO EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:EMANUEL
Last Name:QUILES GUZMAN
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:AVE JUPITER 86C
Mailing Address - Street 2:BDA SANDIN
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694
Mailing Address - Country:US
Mailing Address - Phone:787-366-7445
Mailing Address - Fax:
Practice Address - Street 1:41 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3324
Practice Address - Country:US
Practice Address - Phone:939-458-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33129-R390200000X
PR21943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR66-0964255OtherIRS
PR038041300Medicaid