Healthcare Provider Details

I. General information

NPI: 1588074264
Provider Name (Legal Business Name): NAHIR CORTES SANTIAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-6422
  • Fax:
Mailing address:
  • Phone: 832-824-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10050336
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberS1377
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: