Basic Information
| Provider Information | |||||||||
| NPI: | 1598239303 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CRUZ SANTIAGO | ||||||||
| FirstName: | OMAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 CALLE ZAFIRO | ||||||||
| Address2: | URB COLINAS II | ||||||||
| City: | HATILLO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873168764 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSPITAL PAVIA CARR 129 | ||||||||
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| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2019 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 115460 | PR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.