# SANTIAGO MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790830339
- **Authorized official:** DR. MIGUEL A FUENTES M.D. (PRESIDENT)
- **Authorized official phone:** (401) 312-0444

## Contact information

- **Practice address:** 967 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI 02904-4934
- **Practice address phone:** (401) 312-0444
- **Mailing address:** 967 MINERAL SPRING AVE, NORTH PROVIDENCE, RI 02904-4934
- **Mailing address phone:** (401) 312-0444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 07/15/2009