Provider Demographics
NPI:1851881544
Name:SANTIAGO CARRION, ADA MARIE
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:MARIE
Last Name:SANTIAGO CARRION
Suffix:
Gender:F
Credentials:
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 190152
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0152
Mailing Address - Country:US
Mailing Address - Phone:787-726-1100
Mailing Address - Fax:
Practice Address - Street 1:1801 AVE PONCE DE LEON STE 308
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1917
Practice Address - Country:US
Practice Address - Phone:787-726-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22262207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty