Provider Demographics
NPI:1487695698
Name:SANTANA BURGOS, JAIME E (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:E
Last Name:SANTANA BURGOS
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:PO BOX 1281
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-1281
Mailing Address - Country:US
Mailing Address - Phone:787-889-7218
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO DE PR
Practice Address - Street 2:BARRIO MONACILLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922-2129
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5984OtherPR MEDICAL LICENCE
PRC77555Medicare UPIN
27647Medicare ID - Type Unspecified