Provider Demographics
NPI:1336523687
Name:SANTIAGO, ANGEL M
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
Last Name: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:PO BOX 6868
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5868
Mailing Address - Country:US
Mailing Address - Phone:787-247-7053
Mailing Address - Fax:
Practice Address - Street 1:H16 CALLE LAUREL
Practice Address - Street 2:URB CAMPO ALEGRE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4452
Practice Address - Country:US
Practice Address - Phone:787-247-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies