Provider Demographics
NPI:1194305664
Name:SANTIAGO GUZMAN, JOSE ANGEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:SANTIAGO GUZMAN
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:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1225
Mailing Address - Country:US
Mailing Address - Phone:787-867-1430
Mailing Address - Fax:787-867-4848
Practice Address - Street 1:CARR. 155 KM 31.5
Practice Address - Street 2:BO GATO
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11827183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician