Provider Demographics
NPI:1174900526
Name:PADILLA SANTIAGO, LUIS ANGEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:PADILLA SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L14 CALLE 3
Mailing Address - Street 2:REPARTO UNIVERSIDAD
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-3829
Mailing Address - Country:US
Mailing Address - Phone:787-892-1860
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA # 2 KM 173.4
Practice Address - Street 2:BO CAIN ALTO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18,952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine