Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 18146 | PR |
NPI | 1639445430 |
---|---|
Provider Name | Michelle M Santiago Rivera |
First Address | San Juan, PR 00926-7101 |
Second Address | Rio Piedras, PR 00924-3827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 27/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18146 | LICENCIA MD (01) | PR |