Provider Demographics
NPI:1639520992
Name:ANTONSANTI PHYSICIANS GROUP
Entity Type:Organization
Organization Name:ANTONSANTI PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAINA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ANTONSANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-613-9873
Mailing Address - Street 1:1820 CALLE COVADONGA
Mailing Address - Street 2:URB LA RAMBLA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4077
Mailing Address - Country:US
Mailing Address - Phone:787-613-9873
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 132 KM 24.3
Practice Address - Street 2:SUITE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-651-6876
Practice Address - Fax:787-651-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15805208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty