Provider Demographics
NPI:1750864237
Name:SANTIAGO, DANIEL (CPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:CPH
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 50613
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0613
Mailing Address - Country:US
Mailing Address - Phone:787-516-1612
Mailing Address - Fax:
Practice Address - Street 1:269 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4904
Practice Address - Country:US
Practice Address - Phone:787-796-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013089183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician