Provider Demographics
NPI:1811972250
Name:SANTIAGO, LOURDES (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 PONCE BYPASS
Mailing Address - Street 2:SUITE 508
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1379
Mailing Address - Country:US
Mailing Address - Phone:787-842-9696
Mailing Address - Fax:787-842-9696
Practice Address - Street 1:2225 PONCE BYPASS
Practice Address - Street 2:SUITE 508
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1379
Practice Address - Country:US
Practice Address - Phone:787-842-9696
Practice Address - Fax:787-842-9696
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology