Provider Demographics
NPI:1962506584
Name:FRED SANTANA, ROBERTO R (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:R
Last Name:FRED SANTANA
Suffix:
Gender:M
Credentials:MD FACC
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 2250
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2239
Mailing Address - Country:US
Mailing Address - Phone:787-887-8765
Mailing Address - Fax:787-888-2080
Practice Address - Street 1:AGUSTIN PEREZ ANDINO J-1
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-8765
Practice Address - Fax:787-888-2080
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6898207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4758OtherFIRST MEDICAL
PR7450025OtherHUMANA
PR29063OtherTRIPLE S
D08491Medicare UPIN
PR7450025OtherHUMANA