Provider Demographics
NPI:1902814817
Name:SANTOS, ADA L
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:L
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:L
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-802-0605
Mailing Address - Fax:787-802-0605
Practice Address - Street 1:CARRETERA # 159 KM 13.0
Practice Address - Street 2:SALIDA AHACIA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-802-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15178208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
7830029OtherHUMANA
22083SAOtherSSS
3958OtherPREFERRED MEDICAL CHOICE
2011424OtherPREFFERRED HEALTH
A465OtherFIRST MEDICAL
04271OtherAMERICAN HEALTH
04271OtherAMERICAN HEALTH
22083Medicare ID - Type Unspecified