| Eleazar Viray Santiago Gen Ptr | |
|
660 S Green Valley Pkwy Ste 110 Henderson NV 89052-0431 | |
| (702) 610-8734 | |
| Not Available |
| Full Name | Eleazar Viray Santiago Gen Ptr |
|---|---|
| Speciality | Clinic/Center |
| Location | 660 S Green Valley Pkwy Ste 110, Henderson, Nevada |
| Authorized Official Name and Position | Eleazar Santiago (DOCTOR) |
| Authorized Official Contact | 7026108734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eleazar Viray Santiago Gen Ptr 660 S Green Valley Pkwy Ste 110 Henderson NV 89052-0431 Ph: (702) 610-8734 | Eleazar Viray Santiago Gen Ptr 660 S Green Valley Pkwy Ste 110 Henderson NV 89052-0431 Ph: (702) 610-8734 |
| NPI Number | 1043888936 |
|---|---|
| Provider Enumeration Date | 06/16/2021 |
| Last Update Date | 06/06/2023 |
| Medicare PECOS PAC ID | 3375933906 |
|---|---|
| Medicare Enrollment ID | O20211214000545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043888936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Eleazar Santiago |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1982755898 PECOS PAC ID: 0840610333 Enrollment ID: I20201022001133 |
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