Provider Demographics
NPI:1902344104
Name:SANTOS, JOALIS DOMINGUEZ (RN, BSN)
Entity type:Individual
Prefix:
First Name:JOALIS
Middle Name:DOMINGUEZ
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JOALIS
Other - Middle Name:LOURDES
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 SAPIN LOOP
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1450
Mailing Address - Country:US
Mailing Address - Phone:702-832-7162
Mailing Address - Fax:
Practice Address - Street 1:108 SAPIN LOOP
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1450
Practice Address - Country:US
Practice Address - Phone:702-832-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227160163W00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse