Provider Demographics
NPI:1992811384
Name:ELIEZER CARDONA SANTIAGO
Entity type:Organization
Organization Name:ELIEZER CARDONA SANTIAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-818-3780
Mailing Address - Street 1:61 CALLE PEDRO SANTOS
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4010
Mailing Address - Country:US
Mailing Address - Phone:787-818-3780
Mailing Address - Fax:787-818-3915
Practice Address - Street 1:61 CALLE PEDRO SANTOS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4010
Practice Address - Country:US
Practice Address - Phone:787-818-3780
Practice Address - Fax:787-818-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR02PU9-00000-04740332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4565520001Medicare NSC