Provider Demographics
NPI:1669046066
Name:SANTOS, MARCOS MIGUEL SR
Entity Type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:MIGUEL
Last Name:SANTOS
Suffix:SR
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:URB SAN PEDRO I-30 CALLE TIMOTEO
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-5417
Mailing Address - Country:US
Mailing Address - Phone:787-225-5446
Mailing Address - Fax:
Practice Address - Street 1:60 AVE LOS DOMINICOS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4724
Practice Address - Country:US
Practice Address - Phone:787-795-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9364183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician