Healthcare Provider Details

I. General information

NPI: 1346546868
Provider Name (Legal Business Name): JOSE RIEL SANTONIL SANARIZ CRNA, CCRN, CNRN,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

4619 ARABIA AVE
BALTIMORE MD
21214-3234
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-3045
  • Fax:
Mailing address:
  • Phone: 614-209-7809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR168642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: