Provider Demographics
NPI:1750531125
Name:HERNANDEZ-GAITAN, MANUEL SANTIAGO (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:SANTIAGO
Last Name:HERNANDEZ-GAITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANUEL
Other - Middle Name:SANTIAGO
Other - Last Name:HERNANDEZ-GAITAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 CALLE SAN JUSTO
Mailing Address - Street 2:VIEJO SAN JUAN APARTAMENTO 4
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1414
Mailing Address - Country:US
Mailing Address - Phone:787-384-0049
Mailing Address - Fax:
Practice Address - Street 1:ADMINISTRACION DE SERVICIOS MEDICOS DE PUERTO RICO
Practice Address - Street 2:RADIOLOGIA NEUROENDOVASCULAR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice