1992746424 NPI number — EDWIN SANTIAGO

Table of content: (NPI 1992746424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992746424 NPI number — EDWIN SANTIAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWIN SANTIAGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANTIS AMBULACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992746424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00771-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-733-0837
Provider Business Mailing Address Fax Number:
787-733-0837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 183 KM 18 HM 3
Provider Second Line Business Practice Location Address:
BO. MONTONES
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-733-0837
Provider Business Practice Location Address Fax Number:
787-733-0837
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRADOR
Authorized Official Telephone Number:
787-733-0837

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3416L0300X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50480 . This is a "PREFERED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9004432 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 840464 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7670052 . This is a "HUMANA HEALTH PLANS OF PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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