Healthcare Provider Details

I. General information

NPI: 1295700482
Provider Name (Legal Business Name): TIRZA S SANTIAGO-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N EMERGENCY DEPARTMENT
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

109 G GAINSBOROUGH SQUARE BOX 723
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-6200
  • Fax: 757-312-6181
Mailing address:
  • Phone: 757-490-9388
  • Fax: 757-490-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME92659
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD429320
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15098
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101252749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: