Provider Demographics
NPI:1851722060
Name:SANTIAGO - SANCHEZ, EBENEZER
Entity Type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:
Last Name:SANTIAGO - SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 13 04
Mailing Address - Street 2:VILLA RETIRO
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-678-1829
Mailing Address - Fax:
Practice Address - Street 1:CALLE 13 O4
Practice Address - Street 2:VILLA RETIRO
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-678-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR46406873416L0300X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No3416L0300XTransportation ServicesAmbulanceLand Transport