Provider Demographics
NPI:1366759169
Name:SANTIAGO, DIOMEDES
Entity type:Individual
Prefix:MR
First Name:DIOMEDES
Middle Name:
Last Name: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:HC 1 BOX 3324
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-9522
Mailing Address - Country:US
Mailing Address - Phone:787-450-9665
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:HC 1 BOX 3324
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-9522
Practice Address - Country:US
Practice Address - Phone:787-450-9665
Practice Address - Fax:787-844-4130
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse