Basic Information
| Provider Information | |||||||||
| NPI: | 1750531125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ-GAITAN | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | SANTIAGO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HERNANDEZ-GAITAN | ||||||||
| OtherFirstName: | MANUEL | ||||||||
| OtherMiddleName: | SANTIAGO | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 101 CALLE SAN JUSTO | ||||||||
| Address2: | VIEJO SAN JUAN APARTAMENTO 4 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009011414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873840049 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ADMINISTRACION DE SERVICIOS MEDICOS DE PUERTO RICO | ||||||||
| Address2: | RADIOLOGIA NEUROENDOVASCULAR | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 101E | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.