Provider Demographics
NPI:1922202324
Name:PEREZ SANTIAGO, JANNETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:JANNETTE
Middle Name:
Last Name:PEREZ SANTIAGO
Suffix:
Gender:F
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:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0691
Mailing Address - Country:US
Mailing Address - Phone:787-826-2359
Mailing Address - Fax:787-834-1919
Practice Address - Street 1:EDIF LA PALMA 14 N PERAL ST
Practice Address - Street 2:SUITE 4-B
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-1548
Practice Address - Fax:787-834-1919
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20038OtherPROFESSIONAL LICENSE