1386488609 NPI number — LUIS MANUEL SANTIAGO RN BSN

Table of content: LUIS MANUEL SANTIAGO RN BSN (NPI 1386488609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386488609 NPI number — LUIS MANUEL SANTIAGO RN BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO
Provider First Name:
LUIS
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN BSN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1386488609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 2 BOX 71098
Provider Second Line Business Mailing Address:
BO PALOMAS
Provider Business Mailing Address City Name:
COMERIO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-367-9891
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PASEO DR. JOSE CELSO BARBOSA
Provider Second Line Business Practice Location Address:
UNIVERSIDAD DE PUERTO RICO RECINTO DE CIENCIAS MEDICAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2525
Provider Business Practice Location Address Fax Number:
708-782-4290
Provider Enumeration Date:
06/21/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  G-92245 , 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)





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