Provider Demographics
NPI:1831724632
Name:SANTIAGO RODRIGUEZ, SAUL OMAR
Entity type:Individual
Prefix:
First Name:SAUL
Middle Name:OMAR
Last Name:SANTIAGO RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4G33 CALLE 3A
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-6808
Mailing Address - Country:US
Mailing Address - Phone:787-518-7874
Mailing Address - Fax:
Practice Address - Street 1:4G33 CALLE 3A
Practice Address - Street 2:VILLA DEL REY 4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-6808
Practice Address - Country:US
Practice Address - Phone:787-518-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR23710207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program