Provider Demographics
NPI:1356171714
Name:SANTIAGO, JOSE OSCAR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:OSCAR
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 1:2030 BLVD LUIS A FERRE
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0783
Mailing Address - Country:US
Mailing Address - Phone:787-709-4774
Mailing Address - Fax:
Practice Address - Street 1:2706 AVE MARUCA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4103
Practice Address - Country:US
Practice Address - Phone:787-812-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist