Provider Demographics
NPI:1427609833
Name:SANTOS, TEDDY
Entity type:Individual
Prefix:
First Name:TEDDY
Middle Name:
Last Name:SANTOS
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 1:1210 W DIAMOND ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5970
Mailing Address - Country:US
Mailing Address - Phone:714-820-0084
Mailing Address - Fax:
Practice Address - Street 1:1210 W DIAMOND ST APT 203
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5970
Practice Address - Country:US
Practice Address - Phone:714-820-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider