Healthcare Provider Details

I. General information

NPI: 1598239303
Provider Name (Legal Business Name): OMAR CRUZ SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL PAVIA CARR 129
ARECIBO PR
00562
US

IV. Provider business mailing address

148 CALLE ZAFIRO URB COLINAS II
HATILLO PR
00659
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-7272
  • Fax:
Mailing address:
  • Phone: 787-316-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11018198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number115460
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: