Provider Demographics
NPI:1942403811
Name:VALLES SANTIAGO, CARMEN ANA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ANA
Last Name:VALLES SANTIAGO
Suffix:
Gender:F
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 7886
Mailing Address - Street 2:PMB #495
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7886
Mailing Address - Country:US
Mailing Address - Phone:787-313-0648
Mailing Address - Fax:
Practice Address - Street 1:86 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3942
Practice Address - Country:US
Practice Address - Phone:787-313-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5602261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care