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General NPI Number Information
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NPI Number | 1265661896
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Entity Type | Individual
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Provider Name | SANTIAGO M CORNEJO MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2902 W AGUA FRIA FWY STE 1000
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City | PHOENIX
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State | AZ
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Zip | 85027-3969
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Country | US
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Telephone | 480-485-7371
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 N CENTRAL AVE STE 1001
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City | PHOENIX
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State | AZ
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Zip | 85012-2716
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R71384
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 46120
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License Number State | AZ
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