Provider Demographics
NPI:1669635041
Name:SANTIAGO, WILBUR JOSE
Entity Type:Individual
Prefix:MR
First Name:WILBUR
Middle Name:JOSE
Last Name:SANTIAGO
Suffix:
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:PO BOX 2183
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2183
Mailing Address - Country:US
Mailing Address - Phone:787-502-5512
Mailing Address - Fax:
Practice Address - Street 1:CALLE 6 A-12
Practice Address - Street 2:URB. LOMAS DEL SOL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-502-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation