Provider Demographics
NPI:1780865592
Name:SANTOS INTERVENTIONAL PAIN MEDICINE
Entity Type:Organization
Organization Name:SANTOS INTERVENTIONAL PAIN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISPINO
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-434-7246
Mailing Address - Street 1:PO BOX 33309
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3309
Mailing Address - Country:US
Mailing Address - Phone:702-434-7246
Mailing Address - Fax:702-258-5581
Practice Address - Street 1:7190 SMOKE RANCH RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8397
Practice Address - Country:US
Practice Address - Phone:702-434-7246
Practice Address - Fax:702-258-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8198208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002760Medicaid
NVE03959Medicare UPIN
NV002002760Medicaid