Provider Demographics
NPI:1457434953
Name:SANTIAGO-GONZALEZ, JANISSE N (OD)
Entity Type:Individual
Prefix:
First Name:JANISSE
Middle Name:N
Last Name:SANTIAGO-GONZALEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC - 05 BUY 369723
Mailing Address - Street 2:
Mailing Address - City:SAN SEBESTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-280-4681
Mailing Address - Fax:787-280-4532
Practice Address - Street 1:27 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2211
Practice Address - Country:US
Practice Address - Phone:787-280-4681
Practice Address - Fax:787-280-4532
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU73710Medicare UPIN