Provider Demographics
NPI:1679677108
Name:SANTIAGO PEREZ, ELDA L (RPT)
Entity Type:Individual
Prefix:
First Name:ELDA
Middle Name:L
Last Name:SANTIAGO PEREZ
Suffix:
Gender:F
Credentials:RPT
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 2160
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694
Mailing Address - Country:US
Mailing Address - Phone:787-858-2507
Mailing Address - Fax:
Practice Address - Street 1:B14 CALLE MARGINAL
Practice Address - Street 2:URB FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1546
Practice Address - Fax:787-854-1546
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6740091OtherHUMANA HEALTH PLAN
PR50153OtherIMCS
PR3301737OtherACAA
PR9001874OtherCRUZ AZUL
PR6740091OtherHUMANA INSURANCE
PR84143SAMedicaid
PR223217OtherPREFERRED HEALTH PLAN
PR50193OtherPREFFERED MEDICARE CHOICE
PR870026OtherMEDICARE Y MUCHO MAS MMM
PR6740091OtherHUMANA INSURANCE
PR9001874OtherCRUZ AZUL