Provider Demographics
NPI:1245994847
Name:CANDELARIO-SANTIAGO, LUIS EDUARDO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:EDUARDO
Last Name:CANDELARIO-SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C4 CALLE 201
Mailing Address - Street 2:COLINAS DE FAIRVIEW
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:939-775-6172
Mailing Address - Fax:
Practice Address - Street 1:2505 CARR 841
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3841
Practice Address - Country:US
Practice Address - Phone:787-287-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist