Provider Demographics
NPI:1932203114
Name:RICARDO E SANTIAGO MONTALVO C S P
Entity Type:Organization
Organization Name:RICARDO E SANTIAGO MONTALVO C S P
Other - Org Name:DIAGNOSTIC NUCLEAR MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICINA NUCLEAR
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-997-0303
Mailing Address - Street 1:PO BOX 3643
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LOBBY HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-891-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207U00000X
11830291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty