Provider Demographics
NPI:1205256740
Name:ALEJANDRO SANTIAGO, AXEL E (MD)
Entity type:Individual
Prefix:
First Name:AXEL
Middle Name:E
Last Name:ALEJANDRO 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 1:1554 CALLE LOPEZ LANDRON APT 102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-2188
Mailing Address - Country:US
Mailing Address - Phone:787-204-4900
Mailing Address - Fax:
Practice Address - Street 1:AVE ROBERTO CLEMENTE 124-66 #8
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-2010
Practice Address - Country:US
Practice Address - Phone:787-204-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18718208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice