Provider Demographics
NPI:1700816188
Name:SANTIAGO, DAGMAR L
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:L
Last Name:SANTIAGO
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 1:8151 CONCORDIA EDIF.PROFESIONAL
Mailing Address - Street 2:STE. 2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-842-1272
Mailing Address - Fax:787-840-0985
Practice Address - Street 1:8151 CONCORDIA EDIF PROFESIONAL
Practice Address - Street 2:STE. 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-842-1272
Practice Address - Fax:787-840-0985
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031145Medicare PIN