Provider Demographics
NPI:1194591776
Name:DE SANTIAGO, JEAN C
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:DE 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:AVE. LAUREL, ESQ. AVE. LOS MILLONES
Mailing Address - Street 2:URB. SANTA JUANITA,
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-995-5200
Mailing Address - Fax:
Practice Address - Street 1:AVE. LAUREL, ESQ. AVE. LOS MILLONES
Practice Address - Street 2:URB. SANTA JUANITA,
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-995-5200
Practice Address - Fax:787-787-4343
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90782163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse