Provider Demographics
NPI:1982898458
Name:ROSA, SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SANTIAGO
Other - Middle Name:
Other - Last Name:ROSA JAVIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:BUZON 1185
Mailing Address - Street 2:BO. ESPINAL
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1185
Mailing Address - Country:US
Mailing Address - Phone:787-891-3418
Mailing Address - Fax:
Practice Address - Street 1:BUZON 1185
Practice Address - Street 2:BO. ESPINAL
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-1185
Practice Address - Country:US
Practice Address - Phone:787-891-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE 63381Medicare UPIN