Provider Demographics
NPI:1912080011
Name:BARBOSA SANTOS, MARIA L (OD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:BARBOSA SANTOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA ANDALUCIA
Mailing Address - Street 2:35 CALLE FARAGAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2588
Mailing Address - Country:US
Mailing Address - Phone:787-528-1236
Mailing Address - Fax:
Practice Address - Street 1:11-8 BLQ 33
Practice Address - Street 2:URB. VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986-0697
Practice Address - Country:US
Practice Address - Phone:787-528-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist