Basic Information
| Provider Information | |||||||||
| NPI: | 1972563039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 CALLE CESAR GONZALEZ | ||||||||
| Address2: | APT. 1106 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009183901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877638362 | ||||||||
| FaxNumber: | 7877638362 | ||||||||
| Practice Location | |||||||||
| Address1: | PISO 9, A-989 | ||||||||
| Address2: | CENTRO MEDICO RECINTO DE CIENCIAS MEDICA | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877662844 | ||||||||
| FaxNumber: | 7877581327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 7937 | PR | X | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 7937 | PR | X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 80221 | 01 | PR | TRIPLE-S | OTHER | M-6968 | 01 | PR | CRUZ AZUL | OTHER | 2-7937 | 01 | PR | MCS | OTHER | 3932 | 01 | PR | UNITED HEALTHCARE | OTHER |