Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14911 | PR |
NPI | 1003885823 |
---|---|
Provider Name | Dr. Juan Carlos De Los Santos |
First Address | Caguas, PR 00727 |
Second Address | Caguas, PR 00727-1346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/07/2007 |