Provider Demographics
NPI:1790993053
Name:CAPELLAN, LUIS SANTIAGO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:SANTIAGO
Last Name:CAPELLAN
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 1:2787 CALLE LAS CARROZAS
Mailing Address - Street 2:URB PERLA DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0405
Mailing Address - Country:US
Mailing Address - Phone:787-842-4586
Mailing Address - Fax:787-842-4586
Practice Address - Street 1:2787 CALLE LAS CARROZAS
Practice Address - Street 2:URB PERLA DEL SUR
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0405
Practice Address - Country:US
Practice Address - Phone:787-842-4586
Practice Address - Fax:787-842-4586
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6397208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice