Provider Demographics
NPI:1891752440
Name:SANTIAGO SANTIAGO, JOSE A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:SANTIAGO 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:PO BOX 10730
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0730
Mailing Address - Country:US
Mailing Address - Phone:787-836-3288
Mailing Address - Fax:866-626-2798
Practice Address - Street 1:602 CALLE JOSE V RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1807
Practice Address - Country:US
Practice Address - Phone:787-836-3288
Practice Address - Fax:866-626-2798
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDE665ZOtherMEDICARE
0081480AMedicare ID - Type UnspecifiedPRHC
H08066Medicare UPIN
83678Medicare ID - Type Unspecified