Healthcare Provider Details

I. General information

NPI: 1467222026
Provider Name (Legal Business Name): CHRISTIAN O. PEREZ-SANTIAGO LMBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 THE PLZ
CHARLOTTE NC
28205-5054
US

IV. Provider business mailing address

2505 VETERAN LN APT 3215
CHARLOTTE NC
28205-1980
US

V. Phone/Fax

Practice location:
  • Phone: 704-901-4298
  • Fax:
Mailing address:
  • Phone: 305-928-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number21551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: