Individual
LUIS SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3ACR BLDG 1650, BARKLEY AVE, FT. CARSON, CO 80913
(719) 526-6699
Mailing address
2695 ROCKY MOUNTAIN AVE, STE 150, LOVELAND, CO 80538-9071
(970) 624-4036
(970) 490-4378
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0002445
CO
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03025551
—
CO
Enumeration date
06/13/2006
Last updated
07/27/2016
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