Provider Demographics
NPI:1104584358
Name:SANTIAGO, DERECK NORBERTO (CRNA)
Entity type:Individual
Prefix:
First Name:DERECK
Middle Name:NORBERTO
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CALLE ZUMBADOR
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:787-390-4724
Mailing Address - Fax:
Practice Address - Street 1:CALLE HERNANDEZ CARRION
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006883367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered