Healthcare Provider Details

I. General information

NPI: 1134128333
Provider Name (Legal Business Name): CRISPINO S SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 SMOKE RANCH RD SUITE 150
LAS VEGAS NV
89128-8397
US

IV. Provider business mailing address

PO BOX 33309
LAS VEGAS NV
89133-3309
US

V. Phone/Fax

Practice location:
  • Phone: 702-434-7246
  • Fax: 702-258-5581
Mailing address:
  • Phone: 702-434-7246
  • Fax: 702-258-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8198
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8198
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number8198
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: