Provider Demographics
NPI:1134128333
Name:SANTOS, CRISPINO S (MD)
Entity Type:Individual
Prefix:
First Name:CRISPINO
Middle Name:S
Last Name:SANTOS
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:PO BOX 33309
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3309
Mailing Address - Country:US
Mailing Address - Phone:702-434-7246
Mailing Address - Fax:702-258-5581
Practice Address - Street 1:7190 SMOKE RANCH RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8397
Practice Address - Country:US
Practice Address - Phone:702-434-7246
Practice Address - Fax:702-258-5581
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8198207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-02760Medicaid
NVV101852OtherMEDICARE ID-PIN
NV20-02760Medicaid
E03959Medicare UPIN