Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15017 | PR |
NPI | 1003831611 |
---|---|
Provider Name | Dr. Leopoldo Santiago |
First Address | Maunabo, PR 00707-1256 |
Second Address | Maunabo, PR 00707-2142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 03/02/2011 |