Provider Demographics
NPI:1336751056
Name:SANTIAGO DE LA CRUZ, JOEL ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ISAAC
Last Name:SANTIAGO DE LA CRUZ
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:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0051
Mailing Address - Country:US
Mailing Address - Phone:787-951-5884
Mailing Address - Fax:
Practice Address - Street 1:135 CALLE PROGRESO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4802
Practice Address - Country:US
Practice Address - Phone:787-951-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23581208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice