Provider Demographics
NPI:1780667089
Name:CORA SANTIAGO, VIRGILIO (MD)
Entity Type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:
Last Name:CORA SANTIAGO
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:PMB7999
Mailing Address - Street 2:BOX 120
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681
Mailing Address - Country:US
Mailing Address - Phone:787-868-0000
Mailing Address - Fax:
Practice Address - Street 1:CALLE COLON 125
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6599207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77534Medicare UPIN
PR27434Medicare ID - Type Unspecified