Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 6545 | PR |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 6545 | PR |
NPI | 1528171261 |
---|---|
Provider Name | Dr. Fidel Santos - Santos |
First Address | San Juan, PR 00926-5943 |
Second Address | San Juan, PR 00918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C78234 | (02) | PR |