Provider Demographics
NPI:1285885111
Name:MARIO SANTAELLA MEDICINA INTERNA CSP
Entity type:Organization
Organization Name:MARIO SANTAELLA MEDICINA INTERNA CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAELLA MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-873-4345
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1327
Mailing Address - Country:US
Mailing Address - Phone:787-873-4345
Mailing Address - Fax:787-873-1091
Practice Address - Street 1:17 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-0000
Practice Address - Country:US
Practice Address - Phone:787-873-4345
Practice Address - Fax:787-873-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty