Provider Demographics
NPI:1578296869
Name:AYALA SANTIAGO, CHRISTIAN ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ALBERTO
Last Name:AYALA SANTIAGO
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 1:3700 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7017
Mailing Address - Country:US
Mailing Address - Phone:540-953-3528
Mailing Address - Fax:
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-953-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-03-29
Deactivation Date:2024-03-15
Deactivation Code:
Reactivation Date:2024-03-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program