Provider Demographics
NPI:1649271891
Name:CRUZ-SANTIAGO, JOSE DANIEL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:CRUZ-SANTIAGO
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 1912
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1912
Mailing Address - Country:US
Mailing Address - Phone:787-832-3180
Mailing Address - Fax:787-805-4875
Practice Address - Street 1:60 CALLE POST N
Practice Address - Street 2:206 POST CENTER BLDNG.
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-6659
Practice Address - Country:US
Practice Address - Phone:787-832-3180
Practice Address - Fax:787-805-4875
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08458Medicare UPIN
PR0028448Medicare ID - Type Unspecified