Provider Demographics
NPI:1215086186
Name:SANTIAGO RODRIGUEZ, WILBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:WILBERTO
Middle Name:
Last Name:SANTIAGO RODRIGUEZ
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 1:153 AVE JOSE DE DIEGO E # POST
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-3847
Mailing Address - Country:US
Mailing Address - Phone:787-738-4539
Mailing Address - Fax:787-738-4539
Practice Address - Street 1:153 AVE JOSE DE DIEGO E
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3847
Practice Address - Country:US
Practice Address - Phone:787-738-4539
Practice Address - Fax:787-738-4539
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9350OtherMEDICAL LICENSE
PRG41451Medicare UPIN