Basic Information
| Provider Information | |||||||||
| NPI: | 1891752440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTIAGO SANTIAGO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10730 | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007320730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878363288 | ||||||||
| FaxNumber: | 8666262798 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 CALLE JOSE V RODRIGUEZ | ||||||||
| Address2: | |||||||||
| City: | PENUELAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006241807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878363288 | ||||||||
| FaxNumber: | 8666262798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 8333 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DE665Z | 01 | PR | MEDICARE | OTHER |