Individual
MR. JUAN CARLOS SANTIAGO DE JESUS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
CTIAM, 500 PR-5, BAYAMON, PR 00961
(787) 677-0141
Mailing address
URB. SANTA CLARA, CALLE RESPLANDECIENTE, 186, PONCE, PR 00716
(787) 677-0141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
299040
PR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4696
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932837754
—
PR
Enumeration date
08/10/2022
Last updated
03/05/2024
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