Provider Demographics
NPI:1952440083
Name:SANTA, EILEEN E (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:E
Last Name:SANTA
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 374
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0374
Mailing Address - Country:US
Mailing Address - Phone:787-360-3244
Mailing Address - Fax:
Practice Address - Street 1:CARR 2
Practice Address - Street 2:BO SABALOS CENTRO MEDICO MAYAGUEZ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-360-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11610207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG60623Medicare UPIN
PR89198Medicare ID - Type Unspecified