Provider Demographics
NPI:1588872378
Name:MC CLURG SANTIAGO, DOLORES ANN (0749P)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:ANN
Last Name:MC CLURG SANTIAGO
Suffix:
Gender:F
Credentials:0749P
Other - Prefix:
Other - First Name:GLOBAL
Other - Middle Name:PREHOSPITAL
Other - Last Name:RESPONSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:PUERTO REAL
Mailing Address - State:PR
Mailing Address - Zip Code:00740-0025
Mailing Address - Country:US
Mailing Address - Phone:787-447-7670
Mailing Address - Fax:787-860-4200
Practice Address - Street 1:12 ALTOS GARRIDO MORALES ESQ. SAN RAFAEL
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0000
Practice Address - Country:US
Practice Address - Phone:787-447-7670
Practice Address - Fax:787-860-4200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0749P146L00000X
PRTCAMB5213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic