Provider Demographics
NPI:1003955501
Name:LIZASOAIN SANTIAGO, AIDA M (MD)
Entity type:Individual
Prefix:DR
First Name:AIDA
Middle Name:M
Last Name:LIZASOAIN 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 1:1056 CALLE FERROCARRIL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3028
Mailing Address - Country:US
Mailing Address - Phone:787-764-8937
Mailing Address - Fax:787-767-4763
Practice Address - Street 1:1056 CALLE FERROCARRIL
Practice Address - Street 2:SUITE 1
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3028
Practice Address - Country:US
Practice Address - Phone:787-764-8937
Practice Address - Fax:787-767-4763
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12922208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR500360EOtherMMM
PR20136OtherSSS
PR03220OtherAMERICAN HEALTH
PR0012589OtherHUMANA
PR5884OtherIMC
PRH51502Medicare UPIN
PR20136OtherSSS