Provider Demographics
NPI:1457968323
Name:SANTIAGO LEDEE, KATIA
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:SANTIAGO LEDEE
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:PO BOX 10007 SUITE 413
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785
Mailing Address - Country:US
Mailing Address - Phone:787-981-2428
Mailing Address - Fax:
Practice Address - Street 1:108 CALLE HOSTOS N
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4348
Practice Address - Country:US
Practice Address - Phone:787-981-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22014208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty