Provider Demographics
NPI:1962138685
Name:ROMAN SANTIAGO, CRISTIAN RAFAEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:CRISTIAN
Middle Name:RAFAEL
Last Name:ROMAN SANTIAGO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:CRISTIAN
Other - Middle Name:RAFAEL
Other - Last Name:ROMAN SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:BARRIADA SANDIN CALLE ESCORPIO 19
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-516-6662
Mailing Address - Fax:
Practice Address - Street 1:BARRIADA SANDIN CALLE ESCORPIO 19
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-516-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4249367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty