Provider Demographics
| NPI: | 1619267713 |
|---|---|
| Name: | SANTOS, JOHANNA NOEMI (BA) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | JOHANNA |
| Middle Name: | NOEMI |
| Last Name: | SANTOS |
| Suffix: | |
| Gender: | F |
| Credentials: | BA |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 1601 NW 12 TH AVENUE |
| Mailing Address - Street 2: | UNIVERSITY OF MIAMI/EARLY STEPS |
| Mailing Address - City: | MIAMI |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33136-1005 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 305-243-5600 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1601 NW 12 TH AVENUE |
| Practice Address - Street 2: | UNIVERSITY OF MIAMI/EARLY STEPS |
| Practice Address - City: | MIAMI |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33136-1005 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 305-243-5600 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2011-04-11 |
| Last Update Date: | 2011-04-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| FL | 104100000X, 222Q00000X, 2355S0801X, 235Z00000X | |
| 224Z00000X, 225100000X, 225200000X, 225X00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
| No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
