Provider Demographics
NPI:1023292638
Name:DAGMAR L SANTIAGO
Entity type:Organization
Organization Name:DAGMAR L SANTIAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-842-1272
Mailing Address - Street 1:8151 CONCORDIA EDIF.PROFESIONAL
Mailing Address - Street 2:STE 2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1552
Mailing Address - Country:US
Mailing Address - Phone:787-842-1272
Mailing Address - Fax:787-840-0985
Practice Address - Street 1:8151 CONCORDIA EDIF.PROFESIONAL
Practice Address - Street 2:STE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1552
Practice Address - Country:US
Practice Address - Phone:787-842-1272
Practice Address - Fax:787-840-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031145Medicare PIN