Provider Demographics
NPI:1669445144
Name:SANTIAGO-RIVERA, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SANTIAGO-RIVERA
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:PMB 157
Mailing Address - Street 2:PO BOX 780
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0000
Mailing Address - Country:US
Mailing Address - Phone:787-841-5549
Mailing Address - Fax:787-840-3030
Practice Address - Street 1:909 AVE. TITO CASTRO
Practice Address - Street 2:TORRE MEDICA SAN LUCAS, SUITE 717
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-841-5549
Practice Address - Fax:787-840-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14914OtherSTATE LISCENCE
PRI18048Medicare UPIN
PR22717Medicare ID - Type Unspecified