Provider Demographics
NPI:1124779251
Name:MONTOYO SANTIAGO, JUAN RAMON (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RAMON
Last Name:MONTOYO SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 CALLE BECASINA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3331
Mailing Address - Country:US
Mailing Address - Phone:939-257-6274
Mailing Address - Fax:
Practice Address - Street 1:PLAZA 65 SHOOPING CENTER, 90 C. ALONDRA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:939-318-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23103208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty