Provider Demographics
NPI:1952398844
Name:SANTIAGO SANTIAGO, JOSE EFRAIN
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:EFRAIN
Last Name:SANTIAGO 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 371090
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1090
Mailing Address - Country:US
Mailing Address - Phone:787-738-6189
Mailing Address - Fax:
Practice Address - Street 1:170 AVE MUNOZ RIVERA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4745
Practice Address - Country:US
Practice Address - Phone:787-263-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170100000X
PR7671208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics