Provider Demographics
NPI:1194494542
Name:CRESPO SANTIAGO, ASTRID KRYSTAL (MD)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:KRYSTAL
Last Name:CRESPO SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EL MADRIGAL
Mailing Address - Street 2:CALLE 10 L4
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-247-2107
Mailing Address - Fax:
Practice Address - Street 1:URB. EL MADRIGAL
Practice Address - Street 2:CALLE 10 L4
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-247-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22502208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice