Provider Demographics
NPI:1730275553
Name:SANTIAGO, NORBERTO (MD)
Entity type:Individual
Prefix:
First Name:NORBERTO
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1864
Mailing Address - Country:US
Mailing Address - Phone:787-831-6422
Mailing Address - Fax:787-831-6428
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:MEDICO IV, ST. 208
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-831-6422
Practice Address - Fax:787-831-6428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9157207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE63393Medicare UPIN
PR81892Medicare ID - Type UnspecifiedMEDICARE