Provider Demographics
NPI:1679540462
Name:DIAZ DEL CAMPO, SANTIAGO E (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:E
Last Name:DIAZ DEL CAMPO
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:PO BOX 29756
Mailing Address - Street 2:65 INF. STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0756
Mailing Address - Country:US
Mailing Address - Phone:787-769-6548
Mailing Address - Fax:787-769-6565
Practice Address - Street 1:PQ28 AVE EL COMANDANTE
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-769-6548
Practice Address - Fax:787-769-6565
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78226Medicare UPIN