Provider Demographics
NPI:1194728923
Name:SANTACRUZ, NESTOR DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:DANIEL
Last Name:SANTACRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4205
Mailing Address - Country:US
Mailing Address - Phone:757-583-2181
Mailing Address - Fax:757-480-6482
Practice Address - Street 1:2203 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4205
Practice Address - Country:US
Practice Address - Phone:757-583-2181
Practice Address - Fax:757-480-6482
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010370990Medicaid
12134OtherOPTIMA HEALTH
VA249495OtherANTHEM BCBS
B09939Medicare UPIN
VA00X337K01Medicare ID - Type Unspecified