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General NPI Number Information
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NPI Number | 1982424388
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Entity Type | Organization
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Legal Business Name | AESTHETIC MEDICINE AND SURGERY, PLLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3300
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Country | US
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Telephone | 443-646-5001
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Fax | 410-257-7042
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | MC LEAN
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State | VA
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Zip | 22101-0004
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Country | US
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Telephone | 443-646-5001
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Fax | 410-257-7042
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GABRIEL F SANTIAGO
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Credential | MD, MBA
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Telephone | 443-646-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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