Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 13571 | PR |
NPI | 1104825611 |
---|---|
Provider Name | Ubaldo G Santiago Buono |
First Address | Guaynabo, PR 00966-2205 |
Second Address | San Juan, PR 00907-2243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 16/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0020882 | MEDICARE PTAN (01) | PR |
7000006137 | REMITANCE NO (01) | PR |
H58727 | (02) | PR |