Healthcare Provider Details

I. General information

NPI: 1528417847
Provider Name (Legal Business Name): SANTIAGO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 KEMPSVILLE RD STE 104
NORFOLK VA
23502-3927
US

IV. Provider business mailing address

844 KEMPSVILLE RD STE 104
NORFOLK VA
23502-3927
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-5600
  • Fax: 757-226-0157
Mailing address:
  • Phone: 757-252-5600
  • Fax: 757-226-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number0101274453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: