Provider Demographics
NPI:1013097757
Name:SANTIAGO VIGO, JULIO M (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:M
Last Name:SANTIAGO VIGO
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 1832
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1832
Mailing Address - Country:US
Mailing Address - Phone:787-852-0768
Mailing Address - Fax:787-852-8248
Practice Address - Street 1:HOSPITAL RYDER MEMORIAL INC
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:787-852-8248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR996776OtherMEDICARE Y MUCHOMAS
PR3905OtherPMC
PRC78043Medicare UPIN
PR996776OtherMEDICARE Y MUCHOMAS