Provider Demographics
NPI:1336433036
Name:SANTIAGO, LOURDES
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 YAUCO PLAZA II
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4448
Mailing Address - Country:US
Mailing Address - Phone:787-267-5727
Mailing Address - Fax:787-267-5825
Practice Address - Street 1:643 YAUCO PLAZA II
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4448
Practice Address - Country:US
Practice Address - Phone:787-267-5727
Practice Address - Fax:787-267-5825
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist