Provider Demographics
NPI:1023057577
Name:RUIZ SANTIAGO, POLLY A (MD)
Entity type:Individual
Prefix:DR
First Name:POLLY
Middle Name:A
Last Name:RUIZ SANTIAGO
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 1:20 URBANIZACION CATALANA
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-846-5553
Mailing Address - Fax:787-854-5553
Practice Address - Street 1:20 URB CATALANA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2774
Practice Address - Country:US
Practice Address - Phone:787-846-5553
Practice Address - Fax:787-854-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14036174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14036OtherLICENSE
PRDM-14205-9OtherASSMCA
PRXR7587085OtherSAMSA
PRBR7587085OtherDEA