Provider Demographics
NPI:1407608573
Name:SANTIAGO ESPADA, CESAR OMAR
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:OMAR
Last Name:SANTIAGO ESPADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1613
Mailing Address - Country:US
Mailing Address - Phone:234-275-6580
Mailing Address - Fax:
Practice Address - Street 1:3406 BROADMOOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1613
Practice Address - Country:US
Practice Address - Phone:234-275-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant