1962506584 NPI number — DR. ROBERTO R FRED SANTANA MD FACC

Table of content: DR. ROBERTO R FRED SANTANA MD FACC (NPI 1962506584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962506584 NPI number — DR. ROBERTO R FRED SANTANA MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRED SANTANA
Provider First Name:
ROBERTO
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
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:
1962506584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00745-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-887-8765
Provider Business Mailing Address Fax Number:
787-888-2080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AGUSTIN PEREZ ANDINO J-1
Provider Second Line Business Practice Location Address:
VILLAS DE RIO GRANDE
Provider Business Practice Location Address City Name:
RIO GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-887-8765
Provider Business Practice Location Address Fax Number:
787-888-2080
Provider Enumeration Date:
09/12/2006

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: 207R00000X , with the licence number:  6898 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 6898 , 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: 4758 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7450025 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 29063 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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