Provider Demographics
NPI:1780765594
Name:ROMERO SANTIAGO, ANGEL (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ROMERO 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:GPO 2675 VOLADORAS CONTRACT STATION
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-1725
Mailing Address - Fax:787-877-1725
Practice Address - Street 1:CARR 111 KM 8.0 BO VOLADORAS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-1725
Practice Address - Fax:787-877-1725
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6760020OtherHUMANA
11612280OtherGLOBAL HEALTH
2804OtherAMERICAN HEALTH
20059R0OtherTRIPLE S
PR660687187Medicaid
212658OtherUTI PREFERRED HEALTH
1238OtherMEDICARE PREFERED CHOICE
PE4150OtherPAN AMERICAN LIFE
SK0519OtherGOLDEN CROSS
061565OtherCRUZ AZUL
100106WOtherMEDICARE Y MUCHO MAS
42355OtherPROSSAM
4312280OtherUIA
6760020OtherHUMANA
0020059Medicare ID - Type Unspecified