Provider Demographics
NPI:1508285610
Name:SANTIAGO, GERSON (CRNA)
Entity Type:Individual
Prefix:
First Name:GERSON
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COOP LA HACIENDA APT.17B
Mailing Address - Street 2:STA. JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5447
Mailing Address - Country:US
Mailing Address - Phone:939-216-9361
Mailing Address - Fax:
Practice Address - Street 1:J9 ST. HERMANAS DAVILA
Practice Address - Street 2:DOCTOR'S CENTER HOSPITAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-0000
Practice Address - Country:US
Practice Address - Phone:787-622-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101278367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered