Basic Information
| Provider Information | |||||||||
| NPI: | 1053512434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTIAGO | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALLE2 C 9 | ||||||||
| Address2: | COLINAS VERDES | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009245390 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | PASEO GUILLERMO ARBONA | ||||||||
| Address2: | UNIVERSITY DISTRICT HOSPITAL | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009222116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 02/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15264 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.