Basic Information
Provider Information
NPI: 1003806324
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANTOS ONODA
FirstName: KIYOMI
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 10730
Address2:  
City: PONCE
State: PR
PostalCode: 007320730
CountryCode: US
TelephoneNumber: 7878363288
FaxNumber: 7878363288
Practice Location
Address1: JOSE VICENTE RODRIGUEZ STREET
Address2: STE 602
City: PENUELAS
State: PR
PostalCode: 00624
CountryCode: US
TelephoneNumber: 7878363288
FaxNumber: 7878363288
Other Information
ProviderEnumerationDate: 10/27/2005
LastUpdateDate: 06/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X8100PRY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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