Provider Demographics
NPI:1548842768
Name:KRUMM CABEZAS, SANTIAGO
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:KRUMM CABEZAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 RUSTIC TIMBER LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-7395
Mailing Address - Country:US
Mailing Address - Phone:339-204-7858
Mailing Address - Fax:
Practice Address - Street 1:3414 LOGGERHEAD WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7709
Practice Address - Country:US
Practice Address - Phone:339-204-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA281990390200000X
FLME169707207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program