Provider Demographics
NPI:1821079385
Name:SANTIAGO, EDUARDO A SR (MD)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:A
Last Name:SANTIAGO
Suffix:SR
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:PO BOX 362403
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2403
Mailing Address - Country:US
Mailing Address - Phone:787-765-7650
Mailing Address - Fax:787-766-4038
Practice Address - Street 1:HOSP AUXILLO MUTUO
Practice Address - Street 2:AVE PONCE DE LEON
Practice Address - City:HATA REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-765-7650
Practice Address - Fax:787-766-4038
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2970208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29126AMedicare ID - Type Unspecified
PRD38156Medicare UPIN