Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 11830 | PR |
NPI | 1710962204 |
---|---|
Provider Name | Ricardo E. Santiago |
First Address | Aguadilla, PR 00605-3643 |
Second Address | Aguadilla, PR 00605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G41542 | (02) | PR |