Provider Demographics
NPI:1013035609
Name:CORPUZ, SANTIAGO DAYOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:DAYOAN
Last Name:CORPUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 BEVERLY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3101
Mailing Address - Country:US
Mailing Address - Phone:323-461-4183
Mailing Address - Fax:323-461-0864
Practice Address - Street 1:4643 BEVERLY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3101
Practice Address - Country:US
Practice Address - Phone:323-461-4183
Practice Address - Fax:323-461-0864
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38757207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85170Medicare UPIN