Provider Demographics
NPI:1053389650
Name:SANTIAGO, ANNETTE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:I13 CALLE RIO BAUTA
Mailing Address - Street 2:RIO HONDO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3440
Mailing Address - Country:US
Mailing Address - Phone:787-787-8550
Mailing Address - Fax:
Practice Address - Street 1:I13 CALLE RIO BAUTA
Practice Address - Street 2:RIO HONDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3440
Practice Address - Country:US
Practice Address - Phone:787-787-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR130732080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81512OtherSSS