Provider Demographics
NPI:1467222026
Name:PEREZ-SANTIAGO, CHRISTIAN O (LMBT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:O
Last Name:PEREZ-SANTIAGO
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 VETERAN LN APT 3215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1980
Mailing Address - Country:US
Mailing Address - Phone:305-928-9669
Mailing Address - Fax:
Practice Address - Street 1:1208 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5054
Practice Address - Country:US
Practice Address - Phone:704-901-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21551204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine