Provider Demographics
NPI:1710962204
Name:SANTIAGO, RICARDO E (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:E
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3643
Mailing Address - Street 2:AVE SEVERIANO CUEVAS 18, LOBBY HOSPITAL BUEN SAMARITANO
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3643
Mailing Address - Country:US
Mailing Address - Phone:787-882-1920
Mailing Address - Fax:787-891-2175
Practice Address - Street 1:LOBBY HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:AVE SEVERIANO CUEVAS 18
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-891-2175
Practice Address - Fax:787-891-2175
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11830174400000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41542Medicare UPIN