Provider Demographics
NPI:1346212453
Name:SANTIAGO GONZALEZ, OSVALDO JOSE (MDFACS)
Entity type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:JOSE
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:M
Credentials:MDFACS
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Mailing Address - Street 1:PO BOX 801148
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1148
Mailing Address - Country:US
Mailing Address - Phone:787-259-7077
Mailing Address - Fax:787-259-7026
Practice Address - Street 1:EL SENORIAL PLZ
Practice Address - Street 2:1326 SALUD ST SUITE 121
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1689
Practice Address - Country:US
Practice Address - Phone:787-259-7077
Practice Address - Fax:787-259-7026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2018-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR85292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE34338Medicare UPIN