Basic Information
Provider Information
NPI: 1467863522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARCINIEGAS TORRES
FirstName: SANTIAGO
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1750 EAST KEN PRATT BOULEVARD
Address2:  
City: LONGMONT
State: CO
PostalCode: 80504
CountryCode: US
TelephoneNumber: 7207187000
FaxNumber:  
Practice Location
Address1: 1750 E KEN PRATT BLVD
Address2:  
City: LONGMONT
State: CO
PostalCode: 805045311
CountryCode: US
TelephoneNumber: 7207187000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/12/2014
LastUpdateDate: 09/26/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMT206408PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XDR0059168COY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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