Provider Demographics
NPI:1487697157
Name:CAMPOS SANTIAGO, CARMEN LEONOR (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LEONOR
Last Name:CAMPOS SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3134 CALLE TURPIAL
Mailing Address - Street 2:VILLA DEL CARMEN
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2251
Mailing Address - Country:US
Mailing Address - Phone:787-403-1747
Mailing Address - Fax:
Practice Address - Street 1:CARR. 592 KM 5.6
Practice Address - Street 2:BO AMUELAS #115
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-6574
Practice Address - Country:US
Practice Address - Phone:787-837-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16168208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice