Healthcare Provider Details

I. General information

NPI: 1447145297
Provider Name (Legal Business Name): SANTIAGO CORNU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 ARMSTRONG ST
SAN DIEGO CA
92111-5702
US

IV. Provider business mailing address

3002 ARMSTRONG ST
SAN DIEGO CA
92111-5702
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-9550
  • Fax: 858-571-4544
Mailing address:
  • Phone: 858-277-9550
  • Fax: 858-571-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: