Healthcare Provider Details

I. General information

NPI: 1356929046
Provider Name (Legal Business Name): JOSE JUAN DORESTE SANTIAGO DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO LOS ROBLES EDIF LA CIMA APT 204-B
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

927 SECT PITILLO
MAYAGUEZ PR
00682-7315
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-9514
  • Fax:
Mailing address:
  • Phone: 787-233-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number134749
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11044473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: