Provider Demographics
NPI:1841620424
Name:SANTOS, MAXIMO JR (DNP, NP-C, AAHIVS)
Entity type:Individual
Prefix:
First Name:MAXIMO
Middle Name:
Last Name:SANTOS
Suffix:JR
Gender:M
Credentials:DNP, NP-C, AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 ELM AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3295
Mailing Address - Country:US
Mailing Address - Phone:562-247-7592
Mailing Address - Fax:562-432-5122
Practice Address - Street 1:1043 ELM AVE STE 302
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3295
Practice Address - Country:US
Practice Address - Phone:562-247-7592
Practice Address - Fax:562-432-5122
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011233363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care