Provider Demographics
NPI:1689662371
Name:SANTANA, ANDREA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:321 CALLE GRUS
Mailing Address - Street 2:PARQUE DE ISLA VERDE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1384
Mailing Address - Country:US
Mailing Address - Phone:787-253-1029
Mailing Address - Fax:787-253-1428
Practice Address - Street 1:550 SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBS3743918OtherLIC. NARCTICOS FEDERAL
DM10822-5OtherLIC. NARCOTICO ESTATAL
PR11233OtherLICENCIA ESTATAL
PRBS3743918OtherLIC. NARCOTICO FEDERAL
PRDM10822-5OtherLIC. NARCTICOS ESTATAL
PRBS3743918OtherLIC. NARC�TICOS FEDERAL
PR83427Medicare ID - Type UnspecifiedPROVEEDOR