Provider Demographics
NPI:1649439035
Name:SANTIAGO, OMAR L II
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:L
Last Name:SANTIAGO
Suffix:II
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 1:7 CALLE A
Mailing Address - Street 2:SAN FELIPE
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9417
Mailing Address - Country:US
Mailing Address - Phone:787-898-6128
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE A
Practice Address - Street 2:SAN FELIPE
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9417
Practice Address - Country:US
Practice Address - Phone:787-898-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4616650332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies