Provider Demographics
NPI:1912159112
Name:SANTIAGO, EDWIN
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:SANTIAGO
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:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1808
Mailing Address - Country:US
Mailing Address - Phone:787-733-0837
Mailing Address - Fax:787-733-0837
Practice Address - Street 1:CARR 183 KM 18.5
Practice Address - Street 2:MONTONES 1
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-0837
Practice Address - Fax:787-733-0837
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 3313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6932OtherAMERICAN HEALTH MEDICARE
PR7670052OtherHUMANA HEALTH PLANS OF PR
PR660647056OtherHUMANA GGOLD PLUS
PR50480OtherPMC
PR660647056OtherSALUD DORADA MEDICARE
660647056OtherMAPFRE MEDICARE
PR9004432OtherACAA
PR840464OtherMMM HEALTH CARE
PR56825OtherTRIPLE S
PR660647056OtherMCS CLASSICARE
PR660647056OtherFIRST PLUS
PR50480OtherPMC