Provider Demographics
NPI:1497465850
Name:SANTIAGO, LUIS R JR (RN)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:R
Last Name:SANTIAGO
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 MCCLEARY JACOBY RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9426
Mailing Address - Country:US
Mailing Address - Phone:330-246-0641
Mailing Address - Fax:
Practice Address - Street 1:1461 TOD AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485
Practice Address - Country:US
Practice Address - Phone:330-392-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN189892163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse